Provider Demographics
NPI:1417118951
Name:TABATABAI-MIR, HOOMAN (DPM)
Entity Type:Individual
Prefix:
First Name:HOOMAN
Middle Name:
Last Name:TABATABAI-MIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:HOOMAN
Other - Middle Name:
Other - Last Name:MIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1150 N LOOP 1604 W
Mailing Address - Street 2:SUITE 108-259
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4500
Mailing Address - Country:US
Mailing Address - Phone:210-325-5152
Mailing Address - Fax:
Practice Address - Street 1:1150 N LOOP 1604 W
Practice Address - Street 2:SUITE 108-259
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-4500
Practice Address - Country:US
Practice Address - Phone:210-325-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP59616213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery