Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | E7731 | TX |
NPI | 1023049434 |
---|---|
Provider Name | Dr. Shahriar S Safavi |
First Address | Irving, TX 75061-2244 |
Second Address | Irving, TX 75061-2244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099715702 | (05) | TX |
B26099 | (02) | TX |