Healthcare Provider Details

I. General information

NPI: 1720040686
Provider Name (Legal Business Name): MUSTAFA FIROZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S 4TH ST SUITE A
WILLS POINT TX
75169-2632
US

IV. Provider business mailing address

PO BOX 93090
SOUTHLAKE TX
76092-1090
US

V. Phone/Fax

Practice location:
  • Phone: 903-873-3330
  • Fax:
Mailing address:
  • Phone: 903-873-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberK9527
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberK9527
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK9527
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: