Provider Demographics
NPI:1982688768
Name:MOONAT, SURESH C (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:C
Last Name:MOONAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17030 NANES DR
Mailing Address - Street 2:STE 211
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2503
Mailing Address - Country:US
Mailing Address - Phone:281-440-5925
Mailing Address - Fax:281-440-3324
Practice Address - Street 1:17030 NANES DR
Practice Address - Street 2:STE 211
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2503
Practice Address - Country:US
Practice Address - Phone:281-440-5925
Practice Address - Fax:281-440-3324
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE2748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035642001Medicaid
TX035642001Medicaid
TX00R701Medicare PIN