Provider Demographics
NPI:1851616304
Name:EHSAN, AZAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AZAR
Middle Name:
Last Name:EHSAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 S US HIGHWAY 75
Mailing Address - Street 2:ATTN: HOSPITALIST PROGRAM
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4584
Mailing Address - Country:US
Mailing Address - Phone:903-416-4378
Mailing Address - Fax:903-416-4980
Practice Address - Street 1:5016 S US HIGHWAY 75
Practice Address - Street 2:ATTN: HOSPITALIST PROGRAM
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:903-416-4378
Practice Address - Fax:903-416-4980
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2482207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX293491101Medicaid
TX293491101Medicaid