Provider Demographics
NPI:1760574339
Name:HEDAYATI, MOHROKH A (MD)
Entity Type:Individual
Prefix:MRS
First Name:MOHROKH
Middle Name:A
Last Name:HEDAYATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 HORIZON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7814
Mailing Address - Country:US
Mailing Address - Phone:214-306-4456
Mailing Address - Fax:214-306-4457
Practice Address - Street 1:3142 HORIZON RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7814
Practice Address - Country:US
Practice Address - Phone:214-306-4456
Practice Address - Fax:214-306-4457
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0523208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409816201Medicaid
TX035948107Medicaid