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General NPI Number Information
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NPI Number | 1447710892
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Entity Type | Individual
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Provider Name | MARYBETH CONSTANCE KEISER FARAZDAGHI MD
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Gender | Female
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 6400 FANNIN ST STE 1800
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City | HOUSTON
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State | TX
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Zip | 77030-1526
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Country | US
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Telephone | 507-284-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 FANNIN ST STE 1800
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City | HOUSTON
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State | TX
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Zip | 77030-1526
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Country | US
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Telephone | 713-486-9400
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Fax | 713-486-9595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 67737
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | V1453
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License Number State | TX
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