Provider Demographics
NPI:1336388560
Name:MOZAFFARI, BRIAN BEZORGMEHR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BEZORGMEHR
Last Name:MOZAFFARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3950 N A W GRIMES BLVD
Mailing Address - Street 2:SUITE N102
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3540
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:
Practice Address - Street 1:205 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6814
Practice Address - Country:US
Practice Address - Phone:512-686-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP28992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program