Provider Demographics
NPI:1629022892
Name:MAOZ, TOMMY (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:
Last Name:MAOZ
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 1:102 LAKESIDE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1033
Mailing Address - Country:US
Mailing Address - Phone:917-697-1135
Mailing Address - Fax:
Practice Address - Street 1:24433 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1376
Practice Address - Country:US
Practice Address - Phone:281-394-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08049600207P00000X
TXN2182207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1629022892OtherTRICARE SOUTH
TX202203001Medicaid
TX8BZ887OtherBCBSTX
TX8BZ887OtherBCBSTX
TX202203001Medicaid