Provider Demographics
NPI:1902191455
Name:MASROUR, FARBOD (DO,)
Entity Type:Individual
Prefix:
First Name:FARBOD
Middle Name:
Last Name:MASROUR
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:PO BOX 801344
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-1344
Mailing Address - Country:US
Mailing Address - Phone:972-686-6646
Mailing Address - Fax:214-758-1400
Practice Address - Street 1:2540 N GALLOWAY AVE STE 205
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4813
Practice Address - Country:US
Practice Address - Phone:142-962-4863
Practice Address - Fax:214-758-1400
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9262207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine