Provider Demographics
NPI:1174627764
Name:LEILA G. VIZIROV, M.D., P.A.
Entity Type:Organization
Organization Name:LEILA G. VIZIROV, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:G
Authorized Official - Last Name:VIZIROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-869-4404
Mailing Address - Street 1:PO BOX 926107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-6107
Mailing Address - Country:US
Mailing Address - Phone:713-869-4404
Mailing Address - Fax:713-869-4415
Practice Address - Street 1:1631 NORTH LOOP W
Practice Address - Street 2:SUITE 480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1500
Practice Address - Country:US
Practice Address - Phone:713-869-4404
Practice Address - Fax:713-869-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W278Medicare ID - Type UnspecifiedMONTGOMERY COUNTY, TEXAS
TX00781XMedicare ID - Type UnspecifiedHARRIS COUNTY, TEXAS