Provider Demographics
NPI:1215969274
Name:SULTANA, MUNNAVER (MD)
Entity type:Individual
Prefix:MRS
First Name:MUNNAVER
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 HARRISON
Mailing Address - Street 2:STE 301
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702
Mailing Address - Country:US
Mailing Address - Phone:409-899-5111
Mailing Address - Fax:409-899-5906
Practice Address - Street 1:2955 HARRISON
Practice Address - Street 2:STE 301
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-899-5111
Practice Address - Fax:409-899-5906
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7745207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00BA89OtherBCBS
BA89Medicare ID - Type Unspecified
00BA89OtherBCBS