Provider Demographics
NPI:1326380767
Name:ZEBDA, MOHAMED AWNI
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AWNI
Last Name:ZEBDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W ADOUE ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2718
Mailing Address - Country:US
Mailing Address - Phone:281-824-1480
Mailing Address - Fax:281-220-6407
Practice Address - Street 1:905 N GULF BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541
Practice Address - Country:US
Practice Address - Phone:281-824-1480
Practice Address - Fax:281-220-6407
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ7992208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program