Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35-089772 | OH |
N | 111NI0900X | Internist | 35-089772 | OH |
N | 207R00000X | Internist | L9368 | TX |
N | 111NI0900X | Internist | L9368 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | 35089772 | OH |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 35-089772 | OH |
NPI | 1265468748 |
---|---|
Provider Name | Reza Mehzad |
First Address | Fairfield, OH 45014-5335 |
Second Address | Fairfield, OH 45014-5335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 08/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278600000 | (05) | MN |
2840493 | (05) | OH |
I 18599 | (02) | MN |