Provider Demographics
NPI:1679625859
Name:UDDIN, MOHAMMED SIRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SIRAJ
Last Name:UDDIN
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 1:1733 WESTON BRENT LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3034
Mailing Address - Country:US
Mailing Address - Phone:915-593-1381
Mailing Address - Fax:915-590-5971
Practice Address - Street 1:1733 WESTON BRENT LN
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3034
Practice Address - Country:US
Practice Address - Phone:915-593-1381
Practice Address - Fax:915-590-5971
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27163Medicare UPIN
TXOOPC52Medicare ID - Type Unspecified