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Individual
MR. NOSRATOLLAH HEIDARIAN SR.
Active
Individual
MR. NOSRATOLLAH HEIDARIAN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1043P
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104721036
—
TX
01
—
4209016
AETNA
TX
01
—
B19A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/02/2006
Last updated
07/08/2007
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