Provider Demographics
NPI:1588230072
Name:EDRISSI, AFSHIN (DO)
Entity type:Individual
Prefix:
First Name:AFSHIN
Middle Name:
Last Name:EDRISSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S SWEETWATER ST
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:79096-2428
Mailing Address - Country:US
Mailing Address - Phone:806-826-5581
Mailing Address - Fax:
Practice Address - Street 1:901 S SWEETWATER ST
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:TX
Practice Address - Zip Code:79096-2428
Practice Address - Country:US
Practice Address - Phone:806-826-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV1448207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine