Healthcare Provider Details

I. General information

NPI: 1205342474
Provider Name (Legal Business Name): ZIBA REZAEE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 RANCH ROAD 620 S
LAKEWAY TX
78734-6311
US

IV. Provider business mailing address

1205 RANCH ROAD 620 S STE 201
LAKEWAY TX
78734-6311
US

V. Phone/Fax

Practice location:
  • Phone: 512-263-5100
  • Fax: 512-263-5104
Mailing address:
  • Phone: 512-263-5100
  • Fax: 512-263-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ZIBA REZAEE
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 512-263-5100