Provider Demographics
NPI:1275823346
Name:DR REZA IZADI, P.A.
Entity Type:Organization
Organization Name:DR REZA IZADI, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZADI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-244-3702
Mailing Address - Street 1:3117 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3374
Mailing Address - Country:US
Mailing Address - Phone:972-244-3702
Mailing Address - Fax:888-394-0177
Practice Address - Street 1:3117 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3374
Practice Address - Country:US
Practice Address - Phone:972-244-3702
Practice Address - Fax:888-394-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1689207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty