Provider Demographics
NPI:1265443857
Name:AMIR, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:AMIR
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 1:2821 E PRESIDENT G BUSH H
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4277
Mailing Address - Country:US
Mailing Address - Phone:972-437-9210
Mailing Address - Fax:972-437-9240
Practice Address - Street 1:2821 E PRESIDENT G BUSH H
Practice Address - Street 2:SUITE 301
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-0000
Practice Address - Country:US
Practice Address - Phone:972-437-9210
Practice Address - Fax:972-437-9240
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103776404Medicaid
TX8C7318OtherKAISER
TX0008MAOtherBLUE CROSS BLUE SHIELD
TX8C7318Medicare PIN
TX103776404Medicaid