Provider Demographics
NPI:1316904030
Name:SEIRAFI, REZA DAVID (MD FACS)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:DAVID
Last Name:SEIRAFI
Suffix:
Gender:M
Credentials:MD FACS
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Other - Credentials:
Mailing Address - Street 1:PO BOX 240635
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0635
Mailing Address - Country:US
Mailing Address - Phone:205-435-0938
Mailing Address - Fax:
Practice Address - Street 1:101 E BRUNSON ST STE 300
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2500
Practice Address - Country:US
Practice Address - Phone:334-393-3212
Practice Address - Fax:334-393-8747
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL22745208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG97446Medicare UPIN