Healthcare Provider Details

I. General information

NPI: 1003822826
Provider Name (Legal Business Name): ROOZBEH TAEED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD # 2H.012C
AUSTIN TX
78723-3051
US

IV. Provider business mailing address

715 E 43RD ST
AUSTIN TX
78751-3912
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-3360
  • Fax: 512-380-7532
Mailing address:
  • Phone: 210-557-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberJ4550
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberJ4550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: