MEDICARE: DR. REZA MOBARAK DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	1714	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013962539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REZA MOBARAK DPM

Provider Business Mailing Address
First Line	:	502 N VALLEY PKWY
Second Line	:	STE 2
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3437
Country	:	US
Telephone Number	:	972-316-0902
Fax Number	:	972-316-1161

Provider Business Practice Location Address
First Line	:	502 N VALLEY PKWY
Second Line	:	STE 2
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3437
Country	:	US
Telephone Number	:	972-316-0902
Fax Number	:	972-316-1161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	12/23/2020

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