Individual
DR. MAZYAR MALAKOUTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
505 S NOLEN DR STE A, SOUTHLAKE, TX 76092-9167
(817) 424-1525
(817) 424-3491
Mailing address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R1079
TX
207RG0100X
Gastroenterology Physician
Primary
R1079
TX
208M00000X
Hospitalist Physician
R1079
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371268901
—
TX
01
—
371268902
CSHCN
TX
Enumeration date
04/16/2013
Last updated
07/09/2019
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