Provider Demographics
NPI:1144394354
Name:MIR, FERZANA (MD)
Entity Type:Individual
Prefix:DR
First Name:FERZANA
Middle Name:
Last Name:MIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1273
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1273
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 2360
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-838-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1879207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J7134OtherMEDICARE INDIVIDUAL PTAN#
TX00186WOtherMEDICARE GROUP PTAN #
TX8K7262OtherBCBS
TX8J7134OtherMEDICARE INDIVIDUAL PTAN#