Provider Demographics
NPI:1164522231
Name:MIRZA, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MIRZA
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 56612
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77256-6612
Mailing Address - Country:US
Mailing Address - Phone:832-221-0180
Mailing Address - Fax:
Practice Address - Street 1:5757 WESTHEIMER RD STE 100B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-339-1353
Practice Address - Fax:713-339-1838
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8186208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482040Medicaid
VA00X479R02Medicare PIN
OH2482040Medicaid
OHMI4137521Medicare ID - Type Unspecified