Provider Demographics
NPI:1205129350
Name:MEHTA, MUNIRA (DO)
Entity type:Individual
Prefix:
First Name:MUNIRA
Middle Name:
Last Name:MEHTA
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 1:1603 MEDICAL PKWY STE 330
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7900
Mailing Address - Country:US
Mailing Address - Phone:512-765-7806
Mailing Address - Fax:512-456-7039
Practice Address - Street 1:1603 MEDICAL PKWY STE 330
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-765-7806
Practice Address - Fax:512-456-7039
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP9401207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104264993OtherENDOCRINOLOGY