Provider Demographics
NPI:1427039130
Name:KORDESTANI, ROUZBEH K (MD PA)
Entity type:Individual
Prefix:DR
First Name:ROUZBEH
Middle Name:K
Last Name:KORDESTANI
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3501 SONCY
Mailing Address - Street 2:SUITE 137
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-4932
Mailing Address - Country:US
Mailing Address - Phone:806-322-5438
Mailing Address - Fax:806-322-5505
Practice Address - Street 1:3501 SONCY
Practice Address - Street 2:SUITE 137
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-4932
Practice Address - Country:US
Practice Address - Phone:806-322-5438
Practice Address - Fax:806-322-5505
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0133207XS0106X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172199501Medicaid
TX172199501Medicaid
TX8D2876Medicare PIN