Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | M0489 | TX |
NPI | 1124123450 |
---|---|
Provider Name | Reza J. Mehran |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 02/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
168316101 | (05) | TX |
8P1617 | BCBS (01) | TX |
H51705 | (02) | |
P00391323 | RR MEDICARE (01) | TX |