Provider Demographics
NPI:1215022421
Name:TAJKHANJI, MOIZ ABBAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MOIZ
Middle Name:ABBAS
Last Name:TAJKHANJI
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 1:11355 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233
Mailing Address - Country:US
Mailing Address - Phone:210-654-7200
Mailing Address - Fax:210-654-7211
Practice Address - Street 1:11355 TOEPPERWEINROAD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-654-7200
Practice Address - Fax:210-654-7211
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130844701Medicaid
TXF86907Medicare UPIN
TX8F8937Medicare PIN