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General NPI Number Information
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NPI Number | 1972893501
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Entity Type | Individual
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Provider Name | NEGAR REBECCA MOAZAMI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2011
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 3600 GASTON AVE SUITE 550
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City | DALLAS
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State | TX
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Zip | 75246-1800
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Country | US
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Telephone | 214-820-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 2107 KNOB HILL DR
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City | CORINTH
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State | TX
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Zip | 76210-1918
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Country | US
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Telephone | 214-477-5584
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P5688
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License Number State | TX
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