Provider Demographics
NPI:1164843306
Name:NOUSHIN A FIROUZBAKHT MD PA
Entity Type:Organization
Organization Name:NOUSHIN A FIROUZBAKHT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOUSHIN
Authorized Official - Middle Name:ASHRAFIAN
Authorized Official - Last Name:FIROUZBAKHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-878-2667
Mailing Address - Street 1:1125 S HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4464
Mailing Address - Country:US
Mailing Address - Phone:817-878-2667
Mailing Address - Fax:817-810-9541
Practice Address - Street 1:1125 S HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4464
Practice Address - Country:US
Practice Address - Phone:817-878-2667
Practice Address - Fax:817-810-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty