Organization
M. REZA MIZANI, M.D., P.A.
Active
Other names
South Texas Renal Care Group
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD REZA MIZANI M.D. (PRESIDENT)
(210) 212-8622
Entity
Organization
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 504152, SAINT LOUIS, MO 63150-4152
(210) 212-8622
(210) 212-9197
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017PX
BCBS
TX
05
—
191158801
—
TX
01
—
P00440046
MEDICARE RAILROAD
TX
Enumeration date
12/04/2006
Last updated
07/24/2017
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