Provider Demographics
NPI:1922140599
Name:AZATIAN, ASHOT (MD)
Entity Type:Individual
Prefix:
First Name:ASHOT
Middle Name:
Last Name:AZATIAN
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 1:4401 6TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4700
Mailing Address - Country:US
Mailing Address - Phone:806-687-7394
Mailing Address - Fax:806-793-4780
Practice Address - Street 1:4401 6TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4700
Practice Address - Country:US
Practice Address - Phone:806-687-7394
Practice Address - Fax:806-793-4780
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL52332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1614604-01Medicaid
TX00958PMedicare PIN