Provider Demographics
NPI:1174891899
Name:DAVOODI FAMILY MEDICINE PA
Entity type:Organization
Organization Name:DAVOODI FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBORZ
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DAVOODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-410-3682
Mailing Address - Street 1:3051 CHURCHILL DR
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2713
Mailing Address - Country:US
Mailing Address - Phone:972-410-3682
Mailing Address - Fax:972-410-3683
Practice Address - Street 1:3051 CHURCHILL DR
Practice Address - Street 2:SUITE # 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2713
Practice Address - Country:US
Practice Address - Phone:972-410-3682
Practice Address - Fax:972-410-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2930261QS1200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic