Basic Information
| Provider Information | |||||||||
| NPI: | 1689731606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAILAMI-POUR | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | SHAHZAD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAILAMI-POUR | ||||||||
| OtherFirstName: | SHAHZAD | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 116 HAYDEN ST | ||||||||
| Address2: | |||||||||
| City: | BELZONI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018595213 | ||||||||
| FaxNumber: | 6018598771 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 HAYDEN STREET | ||||||||
| Address2: | |||||||||
| City: | BELZONI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622471252 | ||||||||
| FaxNumber: | 6622473865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 07/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 17099 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00124063 | 05 | MS | MEDICAID | 0124063 | 05 | MS | MEDICAID |