Provider Demographics
NPI:1346557279
Name:MAHMOODUDDIN, FAIZ
Entity Type:Individual
Prefix:
First Name:FAIZ
Middle Name:
Last Name:MAHMOODUDDIN
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 1:18652 MCKAY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5716
Mailing Address - Country:US
Mailing Address - Phone:281-446-1520
Mailing Address - Fax:
Practice Address - Street 1:17207 DE CHIRICO CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6269
Practice Address - Country:US
Practice Address - Phone:281-460-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA319975207R00000X
MO2019024436207R00000X
ARE-12419207R00000X
FLME142168207R00000X
TXP5674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine