Provider Demographics
NPI:1508207499
Name:SOUFI, MOHAMAD KHALED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD KHALED
Middle Name:
Last Name:SOUFI
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0553
Mailing Address - Country:US
Mailing Address - Phone:409-772-1533
Mailing Address - Fax:409-772-4982
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-5303
Practice Address - Country:US
Practice Address - Phone:409-772-1533
Practice Address - Fax:409-772-4982
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6054207RC0000X
OH57.022476207R00000X
TXBP10063911207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine