Provider Demographics
NPI:1588986111
Name:FIROZ MEDICAL GROUP, PA.
Entity type:Organization
Organization Name:FIROZ MEDICAL GROUP, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-282-6015
Mailing Address - Street 1:PO BOX 93090
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1090
Mailing Address - Country:US
Mailing Address - Phone:320-282-6015
Mailing Address - Fax:
Practice Address - Street 1:129 S 4TH ST
Practice Address - Street 2:A
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2632
Practice Address - Country:US
Practice Address - Phone:320-282-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9527207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty