Provider Demographics
NPI:1508199290
Name:DEHGHANI, PAYAM (MD)
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:DEHGHANI
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 1:6800 IH 10 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2038
Mailing Address - Country:US
Mailing Address - Phone:210-271-3203
Mailing Address - Fax:210-476-0937
Practice Address - Street 1:6800 IH 10 W
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2038
Practice Address - Country:US
Practice Address - Phone:210-271-3203
Practice Address - Fax:210-476-0937
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9960174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist