Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 217421 | MA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | M1705 | TX |
NPI | 1104871953 |
---|---|
Provider Name | Dr. Irakli Giorgberidze |
First Address | Houston, TX 77030-2747 |
Second Address | Houston, TX 77030-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 07/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8S9520 | BLUE CROSS BLUE SHIELD (01) | TX |
I40916 | (02) | TX |