Provider Demographics
NPI:1407616980
Name:EISSA, MAHMOUD MOHAMED (DO)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:MOHAMED
Last Name:EISSA
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 1:22999 HWY 59 N STE 105
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4438
Mailing Address - Country:US
Mailing Address - Phone:281-348-3359
Mailing Address - Fax:
Practice Address - Street 1:22999 HWY 59 N STE 105
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4438
Practice Address - Country:US
Practice Address - Phone:281-348-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program