Provider Demographics
NPI:1649273145
Name:KAZHDAN, IRENE (MD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:KAZHDAN
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-994-5411
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:5206 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-5251
Practice Address - Country:US
Practice Address - Phone:210-595-5300
Practice Address - Fax:210-614-8740
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0776207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01547635OtherRAILROAD MEDICARE
TX166147206Medicaid
TX166147204Medicaid
TX166147206Medicaid
TXI03813Medicare UPIN
TX8F7427Medicare PIN