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General NPI Number Information
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NPI Number | 1902191455
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Entity Type | Individual
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Provider Name | FARBOD MASROUR D.O,
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Gender | Male
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 2540 N GALLOWAY AVE STE 205
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City | MESQUITE
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State | TX
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Zip | 75150-4813
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Country | US
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Telephone | 142-962-4863
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Fax | 214-758-1400
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Provider Business Mailing Address
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Address Line | PO BOX 801344
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City | DALLAS
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State | TX
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Zip | 75380-1344
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Country | US
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Telephone | 972-686-6646
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Fax | 214-758-1400
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N9262
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | N9262
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License Number State | TX
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