Provider Demographics
NPI:1114658804
Name:MUSA, AZIZ IBRAHIM
Entity Type:Individual
Prefix:
First Name:AZIZ
Middle Name:IBRAHIM
Last Name:MUSA
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 1:9108 WINDRUSH DR S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6663
Mailing Address - Country:US
Mailing Address - Phone:817-819-4594
Mailing Address - Fax:
Practice Address - Street 1:9108 WINDRUSH DR S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6663
Practice Address - Country:US
Practice Address - Phone:817-819-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program