Individual
DR. KOUROSH REZAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6606 LYNDON B JOHNSON FWY STE 200, DALLAS, TX 75240-6524
(972) 233-1999
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
L1978
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153527002
—
TX
05
—
153527003
—
TX
05
—
153527004
—
TX
01
—
153527005
MEDICAID CSHCN
TX
01
—
8W1049
BCBS
TX
01
—
P00387569
RAILROAD
TX
Enumeration date
05/23/2006
Last updated
04/30/2020
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