MEDICARE: DR. YAZAN JAAFAR ALDERAZI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A2900X	Neurocritical Care Physician	Q8817	TX
2	2084D0003X	Diagnostic Neuroimaging (Psychiatry & Neurology) Physician	Q8817	TX
3	2084N0400X	Neurology Physician	Q8817	TX
4	2085N0700X	Neuroradiology Physician	Q8817	TX
5	2084V0102X	Vascular Neurology Physician	Q8817	TX

General Provider Information

NPI Number	:	1316113251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAZAN JAAFAR ALDERAZI M.D.

Provider Business Mailing Address
First Line	:	450 W MEDICAL CENTER BLVD STE 510
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4233
Country	:	US
Telephone Number	:	281-316-0046
Fax Number	:	281-316-0073

Provider Business Practice Location Address
First Line	:	450 W MEDICAL CENTER BLVD STE 510
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4233
Country	:	US
Telephone Number	:	281-316-0046
Fax Number	:	281-316-0073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	01/13/2022

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