Provider Demographics
NPI:1417184185
Name:GOMAH, MOHAMED E (BSC)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:E
Last Name:GOMAH
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 MUSTANG SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3447
Mailing Address - Country:US
Mailing Address - Phone:832-423-0359
Mailing Address - Fax:
Practice Address - Street 1:1811 MUSTANG SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3447
Practice Address - Country:US
Practice Address - Phone:832-423-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program