Provider Demographics
NPI:1174523872
Name:PAKZABAN, PEYMAN (MDPA)
Entity type:Individual
Prefix:
First Name:PEYMAN
Middle Name:
Last Name:PAKZABAN
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 VISTA RD STE 440
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2162
Mailing Address - Country:US
Mailing Address - Phone:713-941-0008
Mailing Address - Fax:713-941-6262
Practice Address - Street 1:3801 VISTA RD STE 440
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2162
Practice Address - Country:US
Practice Address - Phone:713-941-0008
Practice Address - Fax:713-941-6262
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8305207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6425199OtherCIGNA PIN
TX1320205OtherUNITED HEALTHCARE ID
TXG17452OtherUPIN
TX036295601Medicaid
TX1320205OtherUHC PIN
TX5613188OtherAETNA ID
TX8BL550OtherBCBS ACCOUNT NUMBER AS OF 07/24/2008
TXP00621639OtherRAILROAD MEDICARE PART B
TX00U34TOtherMEDICARE GROUP PTAN
TX8BL550OtherBCBS ACCOUNT NUMBER AS OF 07/24/2008