Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | N3181 | TX |
N | 111NI0900X | Internist | N3181 | TX |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | N3181 | TX |
NPI | 1013063627 |
---|---|
Provider Name | Sasan Mirfakhraee |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 17/08/2012 |