Provider Demographics
NPI:1366561607
Name:AYOUB, MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AYOUB
Suffix:
Gender:M
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 590167
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77259-0167
Mailing Address - Country:US
Mailing Address - Phone:281-335-0300
Mailing Address - Fax:281-335-0355
Practice Address - Street 1:1322 SPACE PARK DRIVE
Practice Address - Street 2:SUITE C 197
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3460
Practice Address - Country:US
Practice Address - Phone:281-335-0300
Practice Address - Fax:281-335-0355
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK92192084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00543TMedicare ID - Type Unspecified
X73784Medicare UPIN