Provider Demographics
NPI:1457597320
Name:SADEGHI, REZA (MD)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:SADEGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:SUITE 2070
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-486-8000
Mailing Address - Fax:713-486-8088
Practice Address - Street 1:1631 N LOOP WEST, STE 245
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008
Practice Address - Country:US
Practice Address - Phone:713-486-8150
Practice Address - Fax:713-486-8155
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP27762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153449704OtherMDCD GRP TPI HARRIS CO
TX0035TDOtherBCBSTX GRP PROV REC #
TX00106WOtherMDCR GRP PTAN HARRIS CO
TXDB6392OtherRR MDCR GRP PTAN