Provider Demographics
NPI:1508206095
Name:ALI, MONSUR (DO)
Entity Type:Individual
Prefix:MR
First Name:MONSUR
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S DENTON TAP RD UNIT 2265
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7705
Mailing Address - Country:US
Mailing Address - Phone:469-619-7192
Mailing Address - Fax:
Practice Address - Street 1:546 E SANDY LAKE RD STE 120
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5793
Practice Address - Country:US
Practice Address - Phone:469-619-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4431207R00000X, 207R00000X
NY302339207R00000X
VA0102204149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine