Provider Demographics
NPI:1023304946
Name:RAZA, ALI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:RAZA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SCHOOL ST STE 15
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4594
Mailing Address - Country:US
Mailing Address - Phone:281-971-0314
Mailing Address - Fax:
Practice Address - Street 1:455 SCHOOL ST STE 15
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4594
Practice Address - Country:US
Practice Address - Phone:281-971-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36854207R00000X
TXR9670207R00000X
NJ25MA09345600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09345600OtherNJ STATE LICENSE
SC368541Medicaid
PAMT199651OtherGRADUATE MEDICAL TRAINEE LICENSE
PAMT199651OtherGRADUATE MEDICAL TRAINEE LICENSE
SCSC42329068Medicare PIN