Healthcare Provider Details

I. General information

NPI: 1649445107
Provider Name (Legal Business Name): PEYMAN PAKZABAN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 VISTA RD STE 440
PASADENA TX
77504-2162
US

IV. Provider business mailing address

3801 VISTA RD STE 440
PASADENA TX
77504-2162
US

V. Phone/Fax

Practice location:
  • Phone: 713-941-0008
  • Fax: 713-941-6262
Mailing address:
  • Phone: 713-941-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberH8305
License Number StateTX

VIII. Authorized Official

Name: STACI LEE VAUDRIN
Title or Position: SENIOR FINANCE COORDINATOR
Credential:
Phone: 713-941-0008