Provider Demographics
NPI:1689637464
Name:GARDEZI, SYED A (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:A
Last Name:GARDEZI
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 1:1628 CRABB RIVER RD STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5890
Mailing Address - Country:US
Mailing Address - Phone:281-545-8090
Mailing Address - Fax:281-545-8339
Practice Address - Street 1:1628 CRABB RIVER RD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5890
Practice Address - Country:US
Practice Address - Phone:281-545-8090
Practice Address - Fax:281-545-8339
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178500801Medicaid
TX00X147Medicare PIN
TXI49279Medicare UPIN