Basic Information
| Provider Information | |||||||||
| NPI: | 1083290712 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MOHAMMADINEJAD | ||||||||
| FirstName: | PAYAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097472849 | ||||||||
| FaxNumber: | 4097727120 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097472849 | ||||||||
| FaxNumber: | 4097727120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2021 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | BP10079529 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.