Provider Demographics
NPI:1023019924
Name:CHAFIZADEH, EDWARD ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ROBERT
Last Name:CHAFIZADEH
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 1:1015 E 32ND ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-807-3140
Mailing Address - Fax:
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:SUITE 508
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-807-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7595207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060046728OtherMEDICARE RAILROAD
TX126591003Medicaid
TX87T087Medicare PIN
TX060046728OtherMEDICARE RAILROAD
TX126591003Medicaid
TX8F21405Medicare PIN