Provider Demographics
NPI:1164979142
Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK
Other - Org Name:TEXAS TECH NEUROIMAGING INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:FACULTY
Authorized Official - Prefix:
Authorized Official - First Name:YAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-743-2391
Mailing Address - Street 1:PO BOX 27476
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0476
Mailing Address - Country:US
Mailing Address - Phone:806-743-4263
Mailing Address - Fax:806-743-5687
Practice Address - Street 1:1008 CANTON AVE
Practice Address - Street 2:ROOM 018BF
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409-3132
Practice Address - Country:US
Practice Address - Phone:806-742-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ88172084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty