Basic Information
| Provider Information | |||||||||
| NPI: | 1538391149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANSOOR | ||||||||
| FirstName: | TARIQ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6431 FANNIN ST STE JJL 324 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007604 | ||||||||
| FaxNumber: | 7135007606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1602 GARTH RD | ||||||||
| Address2: | |||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775202410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818372700 | ||||||||
| FaxNumber: | 2818372760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | P5550 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.