Provider Demographics
NPI:1770571895
Name:VIZIROV, LEILA G (MD)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:G
Last Name:VIZIROV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 926107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-6107
Mailing Address - Country:US
Mailing Address - Phone:713-869-4404
Mailing Address - Fax:713-869-4415
Practice Address - Street 1:1631 NORTH LOOP W
Practice Address - Street 2:SUITE 480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1500
Practice Address - Country:US
Practice Address - Phone:713-869-4404
Practice Address - Fax:713-869-4415
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164020303Medicaid
TX164020302Medicaid
TX8C9696Medicare ID - Type Unspecified