Individual
DR. KNEMA PASCAL REZAEI-BAZAZIZAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1807 W SLAUGHTER LN, SUITE 490, AUSTIN, TX 78748-6230
(512) 282-8967
(512) 406-7351
Mailing address
4515 SETON CENTER PKWY, SUITE 215-CREDENTIALING, AUSTIN, TX 78759-5290
(512) 231-5516
(512) 406-6216
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
BP10043774
TX
208000000X
Pediatrics Physician
Primary
Q3950
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
351475401
—
TX
05
—
351475402
—
TX
Enumeration date
05/29/2012
Last updated
01/12/2016
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