Healthcare Provider Details

I. General information

NPI: 1174800908
Provider Name (Legal Business Name): ASHWINI PRAMOD MEHTA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N BECKLEY AVE STE 268
DALLAS TX
75203-1260
US

IV. Provider business mailing address

1411 N BECKLEY AVE STE 268
DALLAS TX
75203-1260
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberP9906
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberP9906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: