Provider Demographics
NPI:1881658334
Name:NEZHAD, MEHRAN A (MD)
Entity Type:Individual
Prefix:
First Name:MEHRAN
Middle Name:A
Last Name:NEZHAD
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 1:2705 HOSPITAL DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5775
Mailing Address - Country:US
Mailing Address - Phone:361-574-1755
Mailing Address - Fax:361-574-1754
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:SUITE 208
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5775
Practice Address - Country:US
Practice Address - Phone:361-574-1755
Practice Address - Fax:361-574-1754
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019-ACOtherBLUE CROSS BLUE SHIELD
TX0019-ACMedicare ID - Type Unspecified
TXF93368Medicare UPIN