MEDICARE: ALI AZIMPOOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	E3846	TX
2	207T00000X	Neurological Surgery Physician	E3846	TX

General Provider Information

NPI Number	:	1134123862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI AZIMPOOR M.D.

Provider Business Mailing Address
First Line	:	1140 BUSINESS CENTER DR
Second Line	:	SUITE 490
City	:	HOUSTON
State	:	TX
Zip	:	77043-2737
Country	:	US
Telephone Number	:	713-932-1247
Fax Number	:	713-932-1887

Provider Business Practice Location Address
First Line	:	1140 BUSINESS CENTER DR
Second Line	:	SUITE 490
City	:	HOUSTON
State	:	TX
Zip	:	77043-2737
Country	:	US
Telephone Number	:	713-932-1247
Fax Number	:	713-932-1887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/27/2012

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