Provider Demographics
NPI:1942580139
Name:MORADI, MASOUD (DPM)
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:MORADI
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 1:321 INDIAN HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4229
Mailing Address - Country:US
Mailing Address - Phone:817-993-9048
Mailing Address - Fax:
Practice Address - Street 1:1440 N MACARTHUR BLVD STE 101
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4401
Practice Address - Country:US
Practice Address - Phone:817-993-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2119213ES0103X
FLPO3511213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery