Provider Demographics
NPI:1114928520
Name:DARRIGAN, MOHAMMAD REZA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:REZA
Last Name:DARRIGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:DAVID
Other - Last Name:DARRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:12333 WETMORE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3638
Mailing Address - Country:US
Mailing Address - Phone:210-495-6477
Mailing Address - Fax:210-495-6484
Practice Address - Street 1:12333 WETMORE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3638
Practice Address - Country:US
Practice Address - Phone:210-495-6477
Practice Address - Fax:210-495-6484
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213E00000X213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FJ20OtherBCBS OF TEXAS
TX480003153OtherRAILROAD MEDICARE
TX018704901Medicaid
TX00FJ20OtherBCBS OF TEXAS
TXT12906Medicare UPIN
TX00FJ20Medicare ID - Type Unspecified