Individual
MOHAMMAD REZA MIZANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 N SAN SABA STE 301, SAN ANTONIO, TX 78207-8101
(210) 212-8622
(210) 212-9197
Mailing address
PO BOX 650002 DEPT 8286, DALLAS, TX 75265-0002
(210) 212-8622
(210) 212-9197
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L2477
TX
207RN0300X
Nephrology Physician
Primary
L2477
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167912801
—
TX
05
—
167912803
—
TX
Enumeration date
06/01/2005
Last updated
07/22/2024
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