Provider Demographics
NPI:1326207341
Name:SANA, MOAZZAM MOHAMMAD (DO)
Entity Type:Individual
Prefix:
First Name:MOAZZAM
Middle Name:MOHAMMAD
Last Name:SANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N 14TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1112
Mailing Address - Country:US
Mailing Address - Phone:409-833-5858
Mailing Address - Fax:
Practice Address - Street 1:950 N 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1112
Practice Address - Country:US
Practice Address - Phone:409-833-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9124207R00000X, 207RG0100X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP1-0031379Medicaid