Provider Demographics
NPI:1326001843
Name:ABBAS, AGHA MASROOR (MD)
Entity Type:Individual
Prefix:
First Name:AGHA
Middle Name:MASROOR
Last Name:ABBAS
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:DEPT 960390
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:800-684-1573
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:231 S COLLINS RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4624
Practice Address - Country:US
Practice Address - Phone:972-892-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14813R207R00000X
TXM2520207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1156426Medicaid
TX182344513Medicaid
TXP01181269OtherRAILROAD MEDICARE
TXP01181269OtherRAILROAD MEDICARE
LA4F219CM70Medicare ID - Type Unspecified
TX182344513Medicaid