Provider Demographics
NPI:1558356527
Name:SADEGHPOUR, EGHTEDAROLAH (MD)
Entity Type:Individual
Prefix:MR
First Name:EGHTEDAROLAH
Middle Name:
Last Name:SADEGHPOUR
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 1:9180 KATY FWY
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7454
Mailing Address - Country:US
Mailing Address - Phone:713-932-6100
Mailing Address - Fax:713-984-0544
Practice Address - Street 1:9180 KATY FWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7443
Practice Address - Country:US
Practice Address - Phone:713-984-1400
Practice Address - Fax:713-984-0544
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1181207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200022490OtherMEDICARE RAILROAD
PAMDG1181OtherWORKERS COMP
TX00T30ZMedicaid
TX00T30ZOtherBCBS
TX099977301Medicaid
TX00T30ZOtherBCBS
TX00T30ZMedicare PIN