Individual
AREZU DAFTARIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2710 OSLER BLVD, BRYAN, TX 77802-2517
(979) 776-2277
Mailing address
2710 OSLER BLVD, BRYAN, TX 77802-2517
(979) 776-2277
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K5497
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103102308
—
TX
01
—
8BR013
BCBS
TX
05
—
I03102305
—
TX
Enumeration date
04/18/2006
Last updated
03/29/2011
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