Provider Demographics
NPI:1881198133
Name:MANDVIWALA, MURTAZA MUSTAFA (MD)
Entity type:Individual
Prefix:DR
First Name:MURTAZA
Middle Name:MUSTAFA
Last Name:MANDVIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13406 MEDICAL COMPLEX DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3330
Mailing Address - Country:US
Mailing Address - Phone:832-978-2273
Mailing Address - Fax:
Practice Address - Street 1:13406 MEDICAL COMPLEX DR STE 120
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:832-932-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN71370207W00000X
390200000X
TXU8384207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program