Individual
MR. MUSTAK MANSUR MOMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
908 SOUTHMORE AVE, SUITE # 340, PASADENA, TX 77502-1134
(713) 477-0400
(713) 477-2711
Mailing address
13411 GOLDEN FIELD DR, HOUSTON, TX 77059-2834
(281) 461-4865
(281) 461-4865
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K7457
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8620N6
NATIONAL PROVIDER IDENTIF
TX
05
—
P000178Y5
—
TX
Enumeration date
03/19/2007
Last updated
07/08/2007
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