Provider Demographics
NPI:1841458619
Name:MOMIN, SAIRA BANOO (DO)
Entity type:Individual
Prefix:
First Name:SAIRA
Middle Name:BANOO
Last Name:MOMIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 W STATE HIGHWAY 114 STE 340
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8650
Mailing Address - Country:US
Mailing Address - Phone:817-410-7700
Mailing Address - Fax:817-410-7720
Practice Address - Street 1:2020 W STATE HIGHWAY 114 STE 340
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8650
Practice Address - Country:US
Practice Address - Phone:817-410-7700
Practice Address - Fax:817-410-7720
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP1000207ND0101X
NVSL0521207N00000X
FLOS11005207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology