Provider Demographics
NPI:1528206612
Name:PATIENT FIRST MEDICAL GROUP PA
Entity Type:Organization
Organization Name:PATIENT FIRST MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:682-557-4042
Mailing Address - Street 1:PO BOX 96221
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0127
Mailing Address - Country:US
Mailing Address - Phone:682-557-4042
Mailing Address - Fax:817-789-4187
Practice Address - Street 1:7151 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8029
Practice Address - Country:US
Practice Address - Phone:682-557-4042
Practice Address - Fax:817-789-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8396207Q00000X
TXN0121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0070SDOtherBCBS
TX308124201Medicaid
TX0A3182Medicare PIN