Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | K1957 | TX |
Y | 207Q00000X | Family Doctor | K1957 | TX |
N | 208D00000X | General Practice Physician | K1957 | TX |
NPI | 1043201635 |
---|---|
Provider Name | Mr. Hossein Yazdani |
First Address | Anahuac, TX 77514-1703 |
Second Address | Anahuac, TX 77514-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 13/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127093606 | (05) | TX |
8784NO | MEDICARE (01) | TX |
G45012 | (02) | TX |