Basic Information
| Provider Information | |||||||||
| NPI: | 1396165759 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AZIZ | ||||||||
| FirstName: | HIBBA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 SHADOW CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134420000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 VISION PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773843000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134421800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | S4597 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | S4597 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 415415501 | 05 | TX | MEDICAID | 415415503 | 05 | TX | MEDICAID | 415415502 | 05 | TX | MEDICAID |