Provider Demographics
NPI:1093109993
Name:BOUMAZA, IMENE (MD)
Entity type:Individual
Prefix:
First Name:IMENE
Middle Name:
Last Name:BOUMAZA
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 1:6700 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1701
Mailing Address - Country:US
Mailing Address - Phone:806-358-0200
Mailing Address - Fax:806-356-5590
Practice Address - Street 1:6700 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1701
Practice Address - Country:US
Practice Address - Phone:806-358-0200
Practice Address - Fax:806-356-5590
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88108207RC0200X
TXU9714207RP1001X, 207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program