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Individual

MR. NOSRATOLLAH HEIDARIAN SR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
9530 VISCOUNT STE 2P, EL PASO, TX 79925
(915) 591-4499
(915) 591-3011
Mailing address
9530 VISCOUNT STE 2P, EL PASO, TX 79925
(915) 591-4499
(915) 591-3011

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1043P
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1104721036
TX
01
4209016
AETNA
TX
01
B19A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/02/2006
Last updated
07/08/2007
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