Provider Demographics
NPI:1265438683
Name:ALZEERAH, MASOUD A (MD)
Entity type:Individual
Prefix:
First Name:MASOUD
Middle Name:A
Last Name:ALZEERAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S. COULTER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1764
Mailing Address - Country:US
Mailing Address - Phone:806-463-1712
Mailing Address - Fax:806-463-1715
Practice Address - Street 1:1301 S. COULTER
Practice Address - Street 2:SUITE 103
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1764
Practice Address - Country:US
Practice Address - Phone:806-463-1712
Practice Address - Fax:806-463-1715
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3727174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099166302Medicaid
TX099166302Medicaid
TX89600NMedicare ID - Type Unspecified