=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417067240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMYRA MEHKRI MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7120 N WARE RD
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-5819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-227-8504
-----------------------------------------------------
Fax | 956-668-9212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7120 N WARE RD
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-5819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-227-8504
-----------------------------------------------------
Fax | 956-668-9212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / DIRECTOR
-----------------------------------------------------
Name | SUMYRA MEHKRI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-227-8504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | K8336
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------