Provider Demographics
NPI:1609848266
Name:HAQUE, MOHAMMAD AYNAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:AYNAL
Last Name:HAQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:SUITE 570
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:281-944-9813
Mailing Address - Fax:832-321-3433
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:SUITE 570
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:281-944-9813
Practice Address - Fax:832-321-3433
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10017829OtherAMERIGROUP
TX0090EVOtherBCBS OF TX PPO
TX141586101Medicaid
TX136964601Medicaid
TX8A5180AOtherBCBS OF TX
TX8567M0OtherMEDICARE INDIVIDUAL PTAN
TX10017829OtherAMERIGROUP
TX141586101Medicaid
TX0090EVOtherBCBS OF TX PPO