Provider Demographics
NPI:1174541999
Name:SEYSAN, ROYA (MD)
Entity type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:SEYSAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROYA
Other - Middle Name:
Other - Last Name:SEYSAN-SABOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2261 OLYMPIA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1857
Mailing Address - Country:US
Mailing Address - Phone:972-691-8585
Mailing Address - Fax:972-691-8686
Practice Address - Street 1:2261 OLYMPIA DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1857
Practice Address - Country:US
Practice Address - Phone:972-691-8585
Practice Address - Fax:972-691-8686
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89076BMedicare ID - Type Unspecified
TX8J5124Medicare PIN
TXF25149Medicare UPIN