Healthcare Provider Details

I. General information

NPI: 1316113251
Provider Name (Legal Business Name): YAZAN JAAFAR ALDERAZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W MEDICAL CENTER BLVD STE 510
WEBSTER TX
77598-4233
US

IV. Provider business mailing address

450 W MEDICAL CENTER BLVD STE 510
WEBSTER TX
77598-4233
US

V. Phone/Fax

Practice location:
  • Phone: 281-316-0046
  • Fax: 281-316-0073
Mailing address:
  • Phone: 281-316-0046
  • Fax: 281-316-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberQ8817
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberQ8817
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberQ8817
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberQ8817
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberQ8817
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: