Provider Demographics
NPI:1710942727
Name:QAYYUM, MOHSIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSIN
Middle Name:
Last Name:QAYYUM
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:PO BOX 1488
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77549-1488
Mailing Address - Country:US
Mailing Address - Phone:409-245-0795
Mailing Address - Fax:409-245-0750
Practice Address - Street 1:87 INTERSTATE 10 N STE 125
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2548
Practice Address - Country:US
Practice Address - Phone:409-245-0795
Practice Address - Fax:409-245-0750
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN22542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F23292Medicare PIN
TXTXB103252Medicare PIN