Healthcare Provider Details

I. General information

NPI: 1689731606
Provider Name (Legal Business Name): SEAN SHAHZAD DAILAMI-POUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAHZAD DAILAMI-POUR MD

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HAYDEN STREET
BELZONI MS
39038
US

IV. Provider business mailing address

116 HAYDEN ST
BELZONI MS
39038
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-1252
  • Fax: 662-247-3865
Mailing address:
  • Phone: 601-859-5213
  • Fax: 601-859-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17099
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: