Provider Demographics
NPI:1972509230
Name:ETMINAN, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:ETMINAN
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 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:281-344-1715
Mailing Address - Fax:
Practice Address - Street 1:1517 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4932
Practice Address - Country:US
Practice Address - Phone:281-344-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2241207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149358702Medicaid
TX8M3060OtherBLUE CROSS AND BLUE SHIEL
TX149358705Medicaid
TX149358706Medicaid
TX3471057OtherAETNA HMO
TX149358704Medicaid
TX182635700OtherUS DEPT OF LABOR
TX7095249OtherAETNA PPO
TXP01026731OtherRAILROAD MEDICARE
TX149358703Medicaid
TX182635700OtherUS DEPT OF LABOR
TX3471057OtherAETNA HMO
TXTXB143903Medicare PIN
TX149358706Medicaid
TX149358704Medicaid
TX149358702Medicaid