Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 7991 | TX |
NPI | 1578697728 |
---|---|
Provider Name | Mohammad Khakpour |
First Address | Dallas, TX 75240-5299 |
Second Address | Dallas, TX 75240-5789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
605946 | BCBS (01) | TX |
C06092127 | (05) | TX |
U73963 | (02) | TX |