Basic Information
| Provider Information | |||||||||
| NPI: | 1144487174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARYAN | ||||||||
| FirstName: | SAEID | ||||||||
| MiddleName: | ESMAEILY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 E STATE HIGHWAY 114 | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760925251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175027411 | ||||||||
| FaxNumber: | 8175027412 | ||||||||
| Practice Location | |||||||||
| Address1: | 9525 N BEACH ST STE 405 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762446438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175027411 | ||||||||
| FaxNumber: | 8175027412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | P9148 | TX | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 341503601 | 05 | TX | MEDICAID | 8EM652 | 01 | TX | BCBS | OTHER |