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General NPI Number Information
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NPI Number | 1942685409
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Entity Type | Organization
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Legal Business Name | ADVANCED GASTROENTEROLOGY OF TEXAS PLLC
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 2698 NORTH GALLOWAY SUITE 103
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City | MESQUITE
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State | TX
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Zip | 75150
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Country | US
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Telephone | 214-962-4863
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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 | 214-962-4863
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Fax | 214-758-1400
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Authorized Official
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Title or Position | OWNER
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Name | FARBOD MASROUR
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Credential | DO
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Telephone | 214-320-7680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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