Individual
NUSRATH MOHIDEEN HABIBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2363
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2363
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N0813
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198519401
—
TX
01
—
8F9744
BCBS
TX
Enumeration date
09/06/2007
Last updated
02/16/2012
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