Individual
DMITRIY M. NIYAZOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
905 S LASALLE ST, DURHAM, NC 27710-2429
(504) 905-9940
(504) 370-4089
Mailing address
213 CURLEW DR, CHAPEL HILL, NC 27517-7488
(504) 905-9940
(504) 370-4089
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
MD.201813
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09334866
—
MS
05
—
1027987
—
LA
Enumeration date
01/07/2008
Last updated
02/22/2024
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