Provider Demographics
NPI:1093199648
Name:IAGE PHYSICIANS PLLC
Entity type:Organization
Organization Name:IAGE PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ZAFER
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-939-9447
Mailing Address - Street 1:PO BOX 16126
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6126
Mailing Address - Country:US
Mailing Address - Phone:832-939-9447
Mailing Address - Fax:832-999-4322
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 361
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:832-939-9447
Practice Address - Fax:832-999-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352957001Medicaid
TX00T4T9OtherBCBS
TX00T4T9OtherBCBS