Provider Demographics
NPI:1104449990
Name:FAHEID, MOHAMED
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:FAHEID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1120
Mailing Address - Country:US
Mailing Address - Phone:409-772-2166
Mailing Address - Fax:409-772-2663
Practice Address - Street 1:940 W STACY RD STE 110
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5215
Practice Address - Country:US
Practice Address - Phone:214-547-0700
Practice Address - Fax:972-992-2428
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10071307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine