=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942479894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOJDEH ZAHEDI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2008
-----------------------------------------------------
Last Update Date | 12/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15945 CLAYTON RD SUITE 310
-----------------------------------------------------
City | BALLWIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-256-5181
-----------------------------------------------------
Fax | 636-256-5370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15945 CLAYTON RD SUITE 310
-----------------------------------------------------
City | BALLWIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-256-5181
-----------------------------------------------------
Fax | 636-256-5370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | P3271
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2009035024
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------