Provider Demographics
NPI:1417992744
Name:RAZA, QAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:QAMAR
Middle Name:
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WESTLAKE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2649
Mailing Address - Country:US
Mailing Address - Phone:281-310-5040
Mailing Address - Fax:281-310-5045
Practice Address - Street 1:1450 W GRAND PKWY S
Practice Address - Street 2:WEST LAKE HEALTH AND WELLNESS CENTER
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8286
Practice Address - Country:US
Practice Address - Phone:281-310-5040
Practice Address - Fax:281-310-5045
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070916R207P00000X
TXN9942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2039538Medicaid
OH000000317861OtherBCBS
OHP00109738OtherMEDICARE RR
G54130Medicare UPIN
OH000000317861OtherBCBS
RA4016623Medicare PIN