Provider Demographics
NPI:1225037799
Name:FARIVAR-MOHSENI, MIRHASSAN (MD)
Entity Type:Individual
Prefix:
First Name:MIRHASSAN
Middle Name:
Last Name:FARIVAR-MOHSENI
Suffix:
Gender:M
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 118162
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-8162
Mailing Address - Country:US
Mailing Address - Phone:210-587-8888
Mailing Address - Fax:210-587-8889
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE 1033
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-587-8888
Practice Address - Fax:210-587-8889
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3465207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173442802Medicaid
TX8F8908Medicare PIN
TX173442802Medicaid