Individual
S M REZA KHALAFI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 W ROSEDALE ST, FORT WORTH, TX 76104-4681
(817) 885-7442
(817) 885-7443
Mailing address
900 W ROSEDALE ST, FORT WORTH, TX 76104-4681
(817) 885-7442
(817) 885-7443
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
J7032
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115815604
—
TX
01
—
P00292548
RAILROAD MEDICARE
—
Enumeration date
07/13/2006
Last updated
02/11/2019
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