Provider Demographics
NPI:1891767513
Name:MEHDI, MUZAFFAR (MD)
Entity Type:Individual
Prefix:
First Name:MUZAFFAR
Middle Name:
Last Name:MEHDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 LAS COLINAS BLVD W
Mailing Address - Street 2:STE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5421
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-236-0096
Practice Address - Street 1:916 W. ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-941-7611
Practice Address - Fax:972-236-0096
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD66969Medicare UPIN
TX8616M0Medicare ID - Type Unspecified