Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 02003643A | IN |
Y | 207RC0000X | Internist - Cardiovascular Disease | 3601 | TN |
N | 207RC0000X | Internist - Cardiovascular Disease | Q4002 | TX |
NPI | 1003070129 |
---|---|
Provider Name | Homayoun Reza Ahmadian |
First Address | San Antonio, TX 78258-1612 |
Second Address | Germantown, TN 38138-1727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 25/03/2019 |