Healthcare Provider Details

I. General information

NPI: 1003595208
Provider Name (Legal Business Name): FAKEHA MASOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 JBS PKWY STE 100
ODESSA TX
79762-8126
US

IV. Provider business mailing address

3001 JBS PKWY STE 100
ODESSA TX
79762-8126
US

V. Phone/Fax

Practice location:
  • Phone: 432-640-6772
  • Fax: 432-640-4708
Mailing address:
  • Phone: 432-640-6772
  • Fax: 432-640-4708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW4543
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: