Provider Demographics
NPI:1306953716
Name:BEAOUI, MAHFOUDH BEN (PA-C)
Entity type:Individual
Prefix:
First Name:MAHFOUDH
Middle Name:BEN
Last Name:BEAOUI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SOUTH ROSS STERLING
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-0398
Mailing Address - Country:US
Mailing Address - Phone:409-267-3143
Mailing Address - Fax:409-267-4443
Practice Address - Street 1:621 S. ROSS STERLING
Practice Address - Street 2:
Practice Address - City:ANAHUAC
Practice Address - State:TX
Practice Address - Zip Code:77514-0398
Practice Address - Country:US
Practice Address - Phone:409-267-3143
Practice Address - Fax:409-267-4443
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS54707Medicare UPIN