Provider Demographics
NPI:1689675456
Name:VADVA, MOHAMED DAWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:DAWOOD
Last Name:VADVA
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 1:2501 JIMMY JOHNSON BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2009
Mailing Address - Country:US
Mailing Address - Phone:409-983-3221
Mailing Address - Fax:409-983-3222
Practice Address - Street 1:2001 9TH AVE
Practice Address - Street 2:STE 305
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2701
Practice Address - Country:US
Practice Address - Phone:409-983-3221
Practice Address - Fax:409-983-3222
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5042207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81V522OtherBLUE CROSS
TX100006737OtherMEDICARE RAILROAD
TXP081V5226Medicaid
TXP081V5226Medicaid
TX81V522Medicare PIN