Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | J4550 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | J4550 | TX |
NPI | 1003822826 |
---|---|
Provider Name | Roozbeh Taeed |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78207-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 03/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
167575308 | (05) | TX |
167575309 | CSHCN (01) | TX |