Provider Demographics
NPI:1033421235
Name:BERAGDAR, MASHHOOR
Entity Type:Individual
Prefix:
First Name:MASHHOOR
Middle Name:
Last Name:BERAGDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:DEPARTMENT OF GERIATRIC MEDICINE MAIL ROUTE 0177
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0177
Mailing Address - Country:US
Mailing Address - Phone:409-266-9634
Mailing Address - Fax:409-747-3585
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:DEPARTMENT OF GERIATRIC MEDICINE, MAIL ROUTE 0177
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0177
Practice Address - Country:US
Practice Address - Phone:409-266-9634
Practice Address - Fax:409-747-3585
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10036748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine