MEDICARE: ROYA SEYSAN MD

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	207Q00000X	Family Medicine Physician	J5896	TX

General Provider Information

NPI Number	:	1174541999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROYA SEYSAN MD

Provider Business Mailing Address
First Line	:	2261 OLYMPIA DR
Second Line	:	SUITE 100
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1857
Country	:	US
Telephone Number	:	972-691-8585
Fax Number	:	972-691-8686

Provider Business Practice Location Address
First Line	:	2261 OLYMPIA DR
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1857
Country	:	US
Telephone Number	:	972-691-8585
Fax Number	:	972-691-8686

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/12/2013

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