Provider Demographics
NPI:1144517467
Name:AZZAM, MOHAMAD ALI (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:ALI
Last Name:AZZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 58383
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8383
Mailing Address - Country:US
Mailing Address - Phone:832-930-9001
Mailing Address - Fax:
Practice Address - Street 1:220 E MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4319
Practice Address - Country:US
Practice Address - Phone:832-930-9001
Practice Address - Fax:281-672-7162
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106733207LP2900X
TXQ7634208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine