Provider Demographics
NPI:1699705756
Name:ROSHAN, IRAJ (MD)
Entity type:Individual
Prefix:
First Name:IRAJ
Middle Name:
Last Name:ROSHAN
Suffix:
Gender:M
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 847176
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7176
Mailing Address - Country:US
Mailing Address - Phone:903-237-1800
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:1519 W PANOLA ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633
Practice Address - Country:US
Practice Address - Phone:903-694-2871
Practice Address - Fax:903-694-2895
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8747207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029937202Medicaid
P00175649OtherMEDICARE RR
TX8C8775Medicare PIN
P00175649OtherMEDICARE RR
TX8L2419Medicare PIN
P00175649Medicare PIN