Provider Demographics
NPI:1568408375
Name:ROMEZI, MASOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MASOUD
Middle Name:
Last Name:ROMEZI
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 1:933 HILTOP DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:933 HILTOP DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-341-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124013709Medicaid
TX124013702Medicaid
990013500OtherMEDICARE RR
TX332997YQNLMedicare PIN
TX124013709Medicaid
TX8L1580Medicare PIN
TXG22338Medicare UPIN
TX124013702Medicaid
990013500Medicare PIN