Provider Demographics
NPI:1770688558
Name:PARSA, MOHAMMAD REZA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:REZA
Last Name:PARSA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 HWY 51
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-605-8770
Mailing Address - Fax:601-605-8773
Practice Address - Street 1:980 HIGHWAY 51
Practice Address - Street 2:STE B
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-605-8770
Practice Address - Fax:601-605-8773
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80153213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122886Medicaid
MSU48387Medicare UPIN