Organization
EAST TEXAS PSYCHIATRY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAHROKH SAFARIMARYAKI M.D. (OWNER)
(903) 297-6500
Entity
Organization
Contact information
Practice address
22 BERMUDA LN, LONGVIEW, TX 75605-2902
(903) 297-6500
(903) 663-1085
Mailing address
PO BOX 5329, LONGVIEW, TX 75608-5329
(903) 297-6500
(903) 663-1085
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0098KZ
BCBS
TX
05
—
171015401
—
TX
Enumeration date
01/04/2007
Last updated
09/19/2008
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