Individual
DR. FAYYAZ H MIRZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
808 BROOK AVE, WICHITA FALLS, TX 76301-4209
(940) 766-0217
(940) 766-0730
Mailing address
808 BROOK AVE, WICHITA FALLS, TX 76301-4209
(940) 766-0217
(940) 766-0730
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G1118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123812
SUPERIOR HEALTH PLAN
TX
01
—
81R702
BLUE CROSS BLUE SHIELD
TX
01
—
A011
HUMANA MILITARY HEALTHCAR
TX
Enumeration date
12/01/2006
Last updated
12/07/2007
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