Provider Demographics
NPI:1639512395
Name:MONFARED, MARJON (MD)
Entity Type:Individual
Prefix:
First Name:MARJON
Middle Name:
Last Name:MONFARED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5373 W ALABAMA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5932
Mailing Address - Country:US
Mailing Address - Phone:713-552-1112
Mailing Address - Fax:816-207-0230
Practice Address - Street 1:5373 W ALABAMA ST STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5932
Practice Address - Country:US
Practice Address - Phone:713-552-1112
Practice Address - Fax:816-207-0230
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2926207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine