Provider Demographics
NPI:1164679494
Name:MURTAZA MUSSAJI, D.O., P.A.
Entity Type:Organization
Organization Name:MURTAZA MUSSAJI, D.O., P.A.
Other - Org Name:FAIRWAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MURTAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSAJI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-641-3900
Mailing Address - Street 1:4910 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3504
Mailing Address - Country:US
Mailing Address - Phone:713-641-3900
Mailing Address - Fax:713-641-3901
Practice Address - Street 1:4910 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3504
Practice Address - Country:US
Practice Address - Phone:713-641-3900
Practice Address - Fax:713-641-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3335207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F20711Medicare PIN