Provider Demographics
NPI:1861443616
Name:MOHYUDDIN, TAYYAB (MD)
Entity Type:Individual
Prefix:DR
First Name:TAYYAB
Middle Name:
Last Name:MOHYUDDIN
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 1:308 HOLDERRIETH BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4536
Mailing Address - Country:US
Mailing Address - Phone:281-351-4911
Mailing Address - Fax:281-351-4915
Practice Address - Street 1:308 HOLDERRIETH BLVD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4536
Practice Address - Country:US
Practice Address - Phone:281-351-4911
Practice Address - Fax:281-351-4915
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1780207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
008806261IOtherHUMANA
WI34662500Medicaid
TXTXB116754Medicare PIN
I347428Medicare UPIN
TXTXB112177Medicare PIN