Healthcare Provider Details

I. General information

NPI: 1043201635
Provider Name (Legal Business Name): HOSSEIN YAZDANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S KANSAS STREET
ANAHUAC TX
77514-1703
US

IV. Provider business mailing address

PO BOX C
ANAHUAC TX
77514-1703
US

V. Phone/Fax

Practice location:
  • Phone: 409-267-3118
  • Fax: 409-267-3740
Mailing address:
  • Phone: 409-267-3118
  • Fax: 409-267-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK1957
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberK1957
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK1957
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: