Provider Demographics
NPI:1043201635
Name:YAZDANI, HOSSEIN (MD)
Entity Type:Individual
Prefix:MR
First Name:HOSSEIN
Middle Name:
Last Name:YAZDANI
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:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-1703
Mailing Address - Country:US
Mailing Address - Phone:409-267-3118
Mailing Address - Fax:409-267-3740
Practice Address - Street 1:105 S KANSAS STREET
Practice Address - Street 2:
Practice Address - City:ANAHUAC
Practice Address - State:TX
Practice Address - Zip Code:77514-1703
Practice Address - Country:US
Practice Address - Phone:409-267-3118
Practice Address - Fax:409-267-3740
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1957207Q00000X, 208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127093606Medicaid
TX8784NOOtherMEDICARE
TX8784NOOtherMEDICARE
TX8784NOOtherMEDICARE