Provider Demographics
NPI:1447387972
Name:ZIBARI, MOHAMAD S (PA)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:S
Last Name:ZIBARI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 AMBERTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3224
Mailing Address - Country:US
Mailing Address - Phone:682-236-3656
Mailing Address - Fax:
Practice Address - Street 1:9250 AMBERTON PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3224
Practice Address - Country:US
Practice Address - Phone:682-236-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191409501Medicaid
TX191409506Medicaid
TX191409503Medicaid
TX191409504Medicaid
TX191409505Medicaid
TX191409502Medicaid
TX191409504Medicaid
TX191409501Medicaid
TX191409503Medicaid
TX191409502Medicaid
TXTXB124998Medicare PIN
TX8K8868Medicare PIN
TXTXB124995Medicare PIN