Provider Demographics
NPI:1265448732
Name:WALI, GOUHER (MD)
Entity Type:Individual
Prefix:
First Name:GOUHER
Middle Name:
Last Name:WALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 LONG POINT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055
Mailing Address - Country:US
Mailing Address - Phone:713-977-1602
Mailing Address - Fax:713-977-4621
Practice Address - Street 1:8830 LONG POINT
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-977-1602
Practice Address - Fax:713-977-4621
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044539704Medicaid
TX044539704Medicaid
TX8F10068Medicare PIN