Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0432319 | KS |
N | 111NI0900X | Internist | 0432319 | KS |
N | 207R00000X | Internist | 2012024120 | MO |
N | 111NI0900X | Internist | 2012024120 | MO |
N | 207R00000X | Internist | 946196 | KS |
N | 111NI0900X | Internist | 946196 | KS |
N | 207RC0000X | Internist - Cardiovascular Disease | 0432319 | KS |
N | 207RC0000X | Internist - Cardiovascular Disease | 2012024120 | MO |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 0432319 | KS |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 2012024120 | MO |
NPI | 1194847244 |
---|---|
Provider Name | Mazda Biria |
First Address | Merriam, KS 66204-2268 |
Second Address | Merriam, KS 66204-2268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 04/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194847244 | (05) | MO |
701000164 | (02) | MO |
MA4170076 | (02) | MO |