Individual
AMBIR RAUF MIRZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104
(817) 820-4906
Mailing address
PO BOX 8747, FORT WORTH, TX 76124-0747
(817) 451-4208
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L7468
TX
208M00000X
Hospitalist Physician
L7468
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163419801
—
TX
01
—
8H3654
BLUE CROSS & BLUE SHIELD
TX
01
—
P00328249
RAIL ROAD MEDICARE
TX
Enumeration date
10/19/2006
Last updated
08/22/2018
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