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General NPI Number Information
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NPI Number | 1154623072
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Entity Type | Organization
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Legal Business Name | RUKSHAN AZHAR MDPA
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 855 ROLLINGBROOK DR STE 105
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City | BAYTOWN
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State | TX
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Zip | 77521-4073
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Country | US
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Telephone | 713-885-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 2802 GARTH RD STE 105
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City | BAYTOWN
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State | TX
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Zip | 77521-3924
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Country | US
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Telephone | 713-885-5070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUKSHAN AZHAR
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Credential |
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Telephone | 281-428-7997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | J7894
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License Number State | TX
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