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General NPI Number Information
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NPI Number | 1710197298
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Entity Type | Individual
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Provider Name | HAMID R ROODNESHIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 310 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3133
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Country | US
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Telephone | 936-632-8787
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Fax | 936-632-8832
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Provider Business Mailing Address
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Address Line | 910 W 5TH AVE
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City | SPOKANE
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State | WA
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Zip | 99204-2966
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Country | US
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Telephone | 509-838-2531
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R7611
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 52946-20
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License Number State | WI
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