Provider Demographics
NPI:1689932105
Name:NELOFER AZAD, M.D.,P.A.
Entity Type:Organization
Organization Name:NELOFER AZAD, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELOFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:AZAD
Authorized Official - Suffix:
Authorized Official - Credentials:M,D,
Authorized Official - Phone:972-490-6556
Mailing Address - Street 1:12201 MERIT DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2213
Mailing Address - Country:US
Mailing Address - Phone:972-490-6556
Mailing Address - Fax:972-490-6189
Practice Address - Street 1:12201 MERIT DR
Practice Address - Street 2:SUITE 440
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2213
Practice Address - Country:US
Practice Address - Phone:972-490-6556
Practice Address - Fax:972-490-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029880401Medicaid
TX00245MMedicare UPIN