| Advanced Gastroenterology Of Texas Pllc | |
|
2698 North Galloway Suite 103 Mesquite TX 75150 | |
| (214) 962-4863 | |
| (214) 758-1400 |
| Full Name | Advanced Gastroenterology Of Texas Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2698 North Galloway, Mesquite, Texas |
| Authorized Official Name and Position | Farbod Masrour (OWNER) |
| Authorized Official Contact | 2143207680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Gastroenterology Of Texas Pllc Po Box 801344 Dallas TX 75380-1344 Ph: (214) 962-4863 | Advanced Gastroenterology Of Texas Pllc 2698 North Galloway Suite 103 Mesquite TX 75150 Ph: (214) 962-4863 |
| NPI Number | 1942685409 |
|---|---|
| Provider Enumeration Date | 07/27/2015 |
| Last Update Date | 11/05/2015 |
| Medicare PECOS PAC ID | 4284942640 |
|---|---|
| Medicare Enrollment ID | O20151005000805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942685409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | N9262 (Texas) | Primary |
| Provider Name | Farbod Masrour |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902191455 PECOS PAC ID: 1355515594 Enrollment ID: I20111128000079 |
| Provider Name | Massoud Rasooli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720587082 PECOS PAC ID: 3577825280 Enrollment ID: I20180316000946 |
| Provider Name | Anu K Jo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972062594 PECOS PAC ID: 9436570421 Enrollment ID: I20200529000769 |
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