Provider Demographics
NPI:1801095237
Name:UTMB GALVESTON
Entity type:Organization
Organization Name:UTMB GALVESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHD
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALFAWAREH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-747-1309
Mailing Address - Street 1:SPINE DIVISION DEPARTEMNT OF ORTHOPEDICS RM 2.316
Mailing Address - Street 2:301 UNIVERSITY BLD
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0165
Mailing Address - Country:US
Mailing Address - Phone:409-747-1300
Mailing Address - Fax:409-747-1305
Practice Address - Street 1:SPINE DIVISION DEPARTEMNT OF ORTHOPEDICS RM 2.316
Practice Address - Street 2:301 UNIVERSITY BLD
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0165
Practice Address - Country:US
Practice Address - Phone:409-747-1300
Practice Address - Fax:409-747-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10026941282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren