Provider Demographics
NPI:1629074265
Name:FARZAM, STEVEN AMIR (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:AMIR
Last Name:FARZAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAID
Other - Middle Name:
Other - Last Name:AMIRFARZAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:505 N RIDGEWAY DR STE 160
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5191
Mailing Address - Country:US
Mailing Address - Phone:817-774-2774
Mailing Address - Fax:817-774-2776
Practice Address - Street 1:505 N RIDGEWAY DR STE 160
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5191
Practice Address - Country:US
Practice Address - Phone:817-774-2774
Practice Address - Fax:817-774-2776
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8438207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD36362401Medicaid
TXD36362401Medicaid
TX80000NMedicare ID - Type Unspecified