Provider Demographics
NPI:1336571439
Name:MORADI, MEHRAN (DO)
Entity Type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:MORADI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N TX-118
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830
Mailing Address - Country:US
Mailing Address - Phone:432-837-3447
Mailing Address - Fax:
Practice Address - Street 1:2600 N TX-118
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830
Practice Address - Country:US
Practice Address - Phone:432-837-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8307207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine