Basic Information
Provider Information
NPI: 1275732604
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOHADWALA
FirstName: MUSTAFA
MiddleName: MUSTANSIR
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8440 WALNUT HILL LN STE 700
Address2:  
City: DALLAS
State: TX
PostalCode: 752313824
CountryCode: US
TelephoneNumber: 2143613300
FaxNumber: 2143613437
Practice Location
Address1: 8440 WALNUT HILL LN STE 700
Address2:  
City: DALLAS
State: TX
PostalCode: 752313824
CountryCode: US
TelephoneNumber: 2143613300
FaxNumber: 2143613437
Other Information
ProviderEnumerationDate: 07/16/2007
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XP9840TXN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0001XP9840TXY Allopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology

No ID Information.


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