Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | J8442 | TX |
Y | 111NI0900X | Internist | J8442 | TX |
N | 207RG0300X | Geriatric Medicine | J8442 | TX |
NPI | 1144286527 |
---|---|
Provider Name | Marzi Asadifar |
First Address | Austin, TX 78766-1807 |
Second Address | Volente, TX 78641-6108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 14/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1699489 | (05) | LA |
G55439 | (02) |