Provider Demographics
NPI:1487860425
Name:HAMZA, MOHAMMAD KHALID (PHD, PA)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KHALID
Last Name:HAMZA
Suffix:
Gender:M
Credentials:PHD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HWY 365
Mailing Address - Street 2:STE. 200
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6251
Mailing Address - Country:US
Mailing Address - Phone:409-727-5785
Mailing Address - Fax:409-729-0465
Practice Address - Street 1:2300 HWY 365
Practice Address - Street 2:STE. 200
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6251
Practice Address - Country:US
Practice Address - Phone:409-727-5785
Practice Address - Fax:409-729-0465
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33373103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185695702Medicaid
TX185695701Medicaid
TX185695702Medicaid
TX8J7136Medicare PIN