Provider Demographics
NPI:1417094665
Name:MOHAMED O JEROUDI MD PA
Entity Type:Organization
Organization Name:MOHAMED O JEROUDI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:O
Authorized Official - Last Name:JEROUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-230-3379
Mailing Address - Street 1:5060 CRENSHAW RD
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3047
Mailing Address - Country:US
Mailing Address - Phone:832-230-3379
Mailing Address - Fax:832-230-3724
Practice Address - Street 1:5060 CRENSHAW ROAD
Practice Address - Street 2:SUITE # 200
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3047
Practice Address - Country:US
Practice Address - Phone:832-230-3379
Practice Address - Fax:832-230-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1701207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty