Healthcare Provider Details

I. General information

NPI: 1447387972
Provider Name (Legal Business Name): MOHAMAD S ZIBARI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 AMBERTON PKWY
DALLAS TX
75243-3224
US

IV. Provider business mailing address

9250 AMBERTON PKWY
DALLAS TX
75243-3224
US

V. Phone/Fax

Practice location:
  • Phone: 682-236-3656
  • Fax:
Mailing address:
  • Phone: 682-236-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: