Healthcare Provider Details

I. General information

NPI: 1942725585
Provider Name (Legal Business Name): MAHMOOD SYED GHORI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BROADWAY ST STE 110
SAN ANTONIO TX
78205-1912
US

IV. Provider business mailing address

110 BROADWAY ST STE 110
SAN ANTONIO TX
78205-1912
US

V. Phone/Fax

Practice location:
  • Phone: 210-390-1059
  • Fax: 210-342-0606
Mailing address:
  • Phone: 210-390-1059
  • Fax: 210-342-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: