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General NPI Number Information
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NPI Number | 1205199619
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Entity Type | Individual
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Provider Name | MUTHANNA MOHAMMAD SARAIREH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 3600 GASTON AVE STE 904
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City | DALLAS
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State | TX
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Zip | 75246-1809
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Country | US
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Telephone | 214-820-3786
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Fax | 214-820-7367
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Provider Business Mailing Address
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Address Line | 3600 GASTON AVE STE 904
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City | DALLAS
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State | TX
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Zip | 75246-1809
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Country | US
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Telephone | 214-820-3786
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Fax | 214-820-7367
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01077198A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 20001/15604
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License Number State | ZZ
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