Provider Demographics
NPI:1942468103
Name:SEPEHRI, SOGOL (MD)
Entity Type:Individual
Prefix:DR
First Name:SOGOL
Middle Name:
Last Name:SEPEHRI
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 1:11601 FAUBIAN LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4981
Mailing Address - Country:US
Mailing Address - Phone:979-739-1623
Mailing Address - Fax:
Practice Address - Street 1:7000 NORTH MOPAC
Practice Address - Street 2:SUITE # 420
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-482-0045
Practice Address - Fax:512-476-9892
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB137027Medicare PIN
TXTXB106430Medicare PIN
TXTXB137026Medicare PIN