Healthcare Provider Details

I. General information

NPI: 1336437268
Provider Name (Legal Business Name): MOHAMMAD UMAIR D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PENNSYLVANIA AVE
FORT WORTH TX
76104
US

IV. Provider business mailing address

816 W CANNON ST
FORT WORTH TX
76104-3146
US

V. Phone/Fax

Practice location:
  • Phone: 817-321-0404
  • Fax: 817-321-0399
Mailing address:
  • Phone: 817-321-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR0150
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberR0150
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: