Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | N2294 | TX |
NPI | 1366652208 |
---|---|
Provider Name | Alireza Allen Shakouri |
First Address | Southlake, TX 76092-6375 |
Second Address | Southlake, TX 76092-6375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 30/09/2021 |