Individual
BANAFSHEH MOSHIREE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
801 CONOVER DR, GRAND PRAIRIE, TX 75051-1519
(214) 266-3400
(214) 266-3499
Mailing address
801 CONOVER DR, GRAND PRAIRIE, TX 75051-1519
(214) 266-3400
(214) 266-3499
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME88476
FL
207Q00000X
Family Medicine Physician
Primary
Q4814
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269727100
—
FL
Enumeration date
07/05/2005
Last updated
04/25/2016
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