Provider Demographics
NPI:1275037061
Name:NOFFEL, MUATAZ
Entity Type:Individual
Prefix:
First Name:MUATAZ
Middle Name:
Last Name:NOFFEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEDICAL PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7869
Mailing Address - Country:US
Mailing Address - Phone:888-370-1724
Mailing Address - Fax:
Practice Address - Street 1:10 MEDICAL PKWY STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7869
Practice Address - Country:US
Practice Address - Phone:888-370-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN260203241835P1200X
TX579491835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy