Provider Demographics
NPI:1043495500
Name:EGHTEDAR SADEGHPOUR MD PA
Entity type:Organization
Organization Name:EGHTEDAR SADEGHPOUR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EGHTEDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-932-6100
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:256
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-932-6100
Mailing Address - Fax:713-932-6149
Practice Address - Street 1:909 FROSTWOOD DR
Practice Address - Street 2:256
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2301
Practice Address - Country:US
Practice Address - Phone:713-932-6100
Practice Address - Fax:713-932-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085199001Medicaid
TX1013450001Medicare NSC
TX085199001Medicaid