Provider Demographics
NPI:1760658330
Name:MOITHEENNAZIMA, BINUSHA (MD)
Entity type:Individual
Prefix:DR
First Name:BINUSHA
Middle Name:
Last Name:MOITHEENNAZIMA
Suffix:
Gender:F
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:PO BOX 631310
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-1310
Mailing Address - Country:US
Mailing Address - Phone:936-585-4646
Mailing Address - Fax:936-585-4645
Practice Address - Street 1:1209 N MOUND ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4028
Practice Address - Country:US
Practice Address - Phone:936-585-4646
Practice Address - Fax:936-585-4645
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5256207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine