Provider Demographics
NPI:1699043166
Name:MOAZAM PA
Entity Type:Organization
Organization Name:MOAZAM PA
Other - Org Name:HEALTHY HORIZONS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:MOAZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-691-9129
Mailing Address - Street 1:14470 HORIZON BLVD
Mailing Address - Street 2:STE J
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7695
Mailing Address - Country:US
Mailing Address - Phone:915-852-3225
Mailing Address - Fax:915-209-8289
Practice Address - Street 1:1700 W 100TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-5982
Practice Address - Country:US
Practice Address - Phone:915-852-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3405207Q00000X
TXN6499207R00000X, 208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB145513Medicare PIN
TXTXB109214, TXB145513Medicare PIN