Healthcare Provider Details

I. General information

NPI: 1306025143
Provider Name (Legal Business Name): ALIREZA NAZERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 1630
HOUSTON TX
77030-2734
US

IV. Provider business mailing address

2617 S GLEN HAVEN BLVD
HOUSTON TX
77025-2131
US

V. Phone/Fax

Practice location:
  • Phone: 713-909-3166
  • Fax: 713-909-3185
Mailing address:
  • Phone: 832-799-0229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM8206
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberM8206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: