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General NPI Number Information
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NPI Number | 1033421235
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Entity Type | Individual
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Provider Name | MASHHOOR BERAGDAR
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 301 UNIVERSITY BLVD DEPARTMENT OF GERIATRIC MEDICINE, MAIL ROUTE 0177
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City | GALVESTON
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State | TX
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Zip | 77555-0177
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Country | US
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Telephone | 409-266-9634
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Fax | 409-747-3585
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Provider Business Mailing Address
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Address Line | 301 UNIVERSITY BLVD DEPARTMENT OF GERIATRIC MEDICINE MAIL ROUTE 0177
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City | GALVESTON
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State | TX
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Zip | 77555-0177
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Country | US
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Telephone | 409-266-9634
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Fax | 409-747-3585
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BP10036748
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License Number State | TX
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