Healthcare Provider Details

I. General information

NPI: 1023019924
Provider Name (Legal Business Name): EDWARD ROBERT CHAFIZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E 32ND ST SUITE 508
AUSTIN TX
78705-2707
US

IV. Provider business mailing address

1015 E 32ND ST SUITE 508
AUSTIN TX
78705-2707
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-3140
  • Fax:
Mailing address:
  • Phone: 512-807-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberH7595
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: