Provider Demographics
NPI:1326020405
Name:PARVARI, MOHAMMED KHOSRAVI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:KHOSRAVI
Last Name:PARVARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4405
Mailing Address - Country:US
Mailing Address - Phone:940-723-8557
Mailing Address - Fax:940-767-3941
Practice Address - Street 1:1518 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4405
Practice Address - Country:US
Practice Address - Phone:940-723-8557
Practice Address - Fax:940-767-3941
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX60076040OtherCONTROLLED SUBSTANCE CERT
TXBK2391340OtherDRUG ENFORCEMENT AGENCY
TXBK2391340OtherDRUG ENFORCEMENT AGENCY
TXF00828Medicare UPIN