1528215563 NPI number — DR. ASHRAF A. SOOMAR-KHERAJ, INC.

Table of content: (NPI 1528215563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528215563 NPI number — DR. ASHRAF A. SOOMAR-KHERAJ, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ASHRAF A. SOOMAR-KHERAJ, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528215563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 N JOSEY LN
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010-4744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-317-0680
Provider Business Mailing Address Fax Number:
972-317-0690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 N JOSEY LN
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75010-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-317-0680
Provider Business Practice Location Address Fax Number:
972-317-0690
Provider Enumeration Date:
08/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SOOMAR-KHERAJ
Authorized Official First Name:
ASHRAF
Authorized Official Middle Name:
ALAUDDIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-317-0680

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  10490 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1093903007 . This is a "NPI - TYPE 1" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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