Provider Demographics
NPI:1568872620
Name:HERAVI, HOOMAN (MD)
Entity Type:Individual
Prefix:
First Name:HOOMAN
Middle Name:
Last Name:HERAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOOMAN
Other - Middle Name:
Other - Last Name:RAHIMZADEH HERAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:469-291-3369
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5223 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-648-6400
Practice Address - Fax:214-648-5461
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7054207L00000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program