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General NPI Number Information
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NPI Number | 1720319296
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Entity Type | Organization
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Legal Business Name | SHAYAN A. IZADDOOST, M.D., P.L.L.C.
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Dates
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Enumeration Date | 01/23/2010
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Last Update Date | 01/23/2010
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Provider Practice Location Address
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Address Line | 3936 MILTON ST
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City | HOUSTON
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State | TX
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Zip | 77005-2848
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Country | US
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Telephone | 832-350-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 3936 MILTON ST
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City | HOUSTON
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State | TX
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Zip | 77005-2848
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Country | US
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Telephone | 832-350-1020
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SHAYAN A IZADDOOST
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Credential | MD, PHD
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Telephone | 832-350-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | N0850
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License Number State | TX
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