Individual
MOJGAN TAVAKOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
4461 COIT RD, SUITE 409, FRISCO, TX 75035-0526
(972) 712-7773
(972) 712-3134
Mailing address
4461 COIT RD, SUITE 409, FRISCO, TX 75035-0526
(972) 712-7773
(972) 712-3134
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1549
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148568201
—
TX
05
—
148569001
—
TX
01
—
752946496
COMMERCIAL
TX
01
—
8B8721
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/15/2006
Last updated
04/10/2008
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