Provider Demographics
NPI:1962410647
Name:LATIFF, NOOREAHMED (PA)
Entity type:Individual
Prefix:
First Name:NOOREAHMED
Middle Name:
Last Name:LATIFF
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:SUITE B452
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3620
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:SUITE B452
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188048601Medicaid
TXP01254103OtherMEDICARE RR
TX8374NDOtherBLUE CROSS BLUE SHIELD
TX8V3349OtherBLUE CROSS BLUE SHIELD
TX188048603Medicaid
TXP01078445OtherRR MEDICARE
TX188048602Medicaid
TX616192200OtherUS DEPT OF LABOR
TX484867ZSWDMedicare PIN
TX616192200OtherUS DEPT OF LABOR
TXP01078445OtherRR MEDICARE
TX188048602Medicaid