Provider Demographics
NPI:1558586594
Name:SEIJARI, WAHDE (LSA)
Entity Type:Individual
Prefix:DR
First Name:WAHDE
Middle Name:
Last Name:SEIJARI
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WOODLAKE SQ
Mailing Address - Street 2:208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3207
Mailing Address - Country:US
Mailing Address - Phone:936-271-2438
Mailing Address - Fax:936-271-2439
Practice Address - Street 1:18 WOODLAKE SQ
Practice Address - Street 2:208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3207
Practice Address - Country:US
Practice Address - Phone:936-271-2438
Practice Address - Fax:936-271-2439
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00096363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000072JROtherBLUE CROSS BLUE SHIELD