Provider Demographics
NPI:1720040686
Name:FIROZ, MUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:FIROZ
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:PO BOX 93090
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1090
Mailing Address - Country:US
Mailing Address - Phone:903-873-3330
Mailing Address - Fax:
Practice Address - Street 1:129 S 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2632
Practice Address - Country:US
Practice Address - Phone:903-873-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9527207RG0300X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30179Medicare UPIN