=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306025143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALIREZA NAZERI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2007
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 FANNIN ST STE 1630
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-909-3166
-----------------------------------------------------
Fax | 713-909-3185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2617 S GLEN HAVEN BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77025-2131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-799-0229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | M8206
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0001X
-----------------------------------------------------
Taxonomy Name | Clinical Cardiac Electrophysiology Physician
-----------------------------------------------------
License Number | M8206
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------