Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 12863 | TX |
NPI | 1922467133 |
---|---|
Provider Name | Mr. Shahram Shakeri |
First Address | Houston, TX 77084 |
Second Address | Houston, TX 77074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2016 |
Last Update Date | 16/02/2016 |