Provider Demographics
NPI:1003822826
Name:TAEED, ROOZBEH (MD)
Entity Type:Individual
Prefix:
First Name:ROOZBEH
Middle Name:
Last Name:TAEED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3912
Mailing Address - Country:US
Mailing Address - Phone:210-557-1218
Mailing Address - Fax:
Practice Address - Street 1:4900 MUELLER BLVD # 2H.012C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3051
Practice Address - Country:US
Practice Address - Phone:512-324-3360
Practice Address - Fax:512-380-7532
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ45502080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167575309OtherCSHCN
TX167575308Medicaid
TXTXB151367Medicare PIN