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General NPI Number Information
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NPI Number | 1851624589
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Entity Type | Organization
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Legal Business Name | MANOOCHEHR KHATAMI, M.D., P.A.
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 5939 HARRY HINES BLVD STE 823
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City | DALLAS
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State | TX
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Zip | 75235-6243
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Country | US
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Telephone | 214-631-0502
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Fax | 214-631-2567
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Provider Business Mailing Address
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Address Line | 5939 HARRY HINES BLVD STE 823
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City | DALLAS
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State | TX
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Zip | 75235-6243
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Country | US
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Telephone | 214-631-0502
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Fax | 214-631-2567
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Authorized Official
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Title or Position | SECRETARY
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Name | LIZ WYNN
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Credential |
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Telephone | 214-631-0502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | F8781
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License Number State | TX
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