Individual
ALI AZIZZADEH FARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6410 FANNIN ST, 450, HOUSTON, TX 77030-3000
(713) 500-5304
Mailing address
PO BOX 301173, DALLAS, TX 75303-1173
(713) 500-3500
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
L5983
TX
2086S0129X
Vascular Surgery Physician
Primary
L5983
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166110001
—
TX
01
—
166110002
CSHCN
TX
01
—
8P2580
BCBS
TX
Enumeration date
07/11/2006
Last updated
07/28/2016
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