Provider Demographics
NPI:1740244730
Name:MOUSTAPHA, ALI L (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:L
Last Name:MOUSTAPHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1604 HOSPITAL PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6931
Mailing Address - Country:US
Mailing Address - Phone:817-684-9970
Mailing Address - Fax:844-290-4362
Practice Address - Street 1:1604 HOSPITAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6986
Practice Address - Country:US
Practice Address - Phone:817-684-9970
Practice Address - Fax:844-290-4362
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1953207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171594802Medicaid
TX8F1173OtherBCBS
TX8F1173OtherBCBS
TX8G5359Medicare PIN
TX876047Medicare UPIN