Individual
DR. RASSA SHAHIDZADEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4708 ALLIANCE BLVD, SUITE 300, BAYLOR MEDICAL PLAZA 1, PLANO, TX 75093-5340
(972) 758-6000
(972) 758-6001
Mailing address
4708 ALLIANCE BLVD, SUITE 300, BAYLOR MEDICAL PLAZA 1, PLANO, TX 75093-5340
(972) 758-6000
(972) 758-6001
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
055794
GA
207RG0100X
Gastroenterology Physician
Primary
L6176
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055794
GEORGIA STATE LICENSE
GA
05
—
202721101
—
TX
05
—
202721102
—
TX
01
—
8BG110
BCBS
TX
01
—
L6176
TEXAS STATE LICENSE
TX
Enumeration date
04/02/2007
Last updated
11/18/2010
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