Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | BP10060951 | TX |
Y | 208600000X | Surgeon | BP10060951 | TX |
NPI | 1013445246 |
---|---|
Provider Name | Mohammadali Mohajel Shoja |
First Address | Galveston, TX 77555-0534 |
Second Address | Galveston, TX 77555-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2017 |
Last Update Date | 01/06/2017 |