Provider Demographics
NPI:1174512131
Name:HADDAD, MAURICE S (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:S
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 CRENSHAW RD
Mailing Address - Street 2:#200
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3139
Mailing Address - Country:US
Mailing Address - Phone:281-998-2488
Mailing Address - Fax:281-998-2482
Practice Address - Street 1:5050 CRENSHAW RD
Practice Address - Street 2:#200
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3139
Practice Address - Country:US
Practice Address - Phone:281-998-2488
Practice Address - Fax:281-998-2482
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3065207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128002602Medicaid
TX86Y161Medicare PIN
TXC16424Medicare UPIN
00U25BMedicare PIN