# ALI AZIZZADEH FARD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1780618918
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | L5983 | TX | — |
| 2086S0129X | Vascular Surgery Physician | L5983 | TX | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 07/28/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 166110001 | — | TX |
| 01 | — | 166110002 | CSHCN | TX |
| 01 | — | 8P2580 | BCBS | TX |