Basic Information
| Provider Information | |||||||||
| NPI: | 1932458502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLHPOUR | ||||||||
| FirstName: | AMIRREZA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 GASLIGHT BLVD | ||||||||
| Address2: | |||||||||
| City: | LUFKIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759043133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9366328787 | ||||||||
| FaxNumber: | 9366328832 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 GASLIGHT BLVD | ||||||||
| Address2: | |||||||||
| City: | LUFKIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759043133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9366328787 | ||||||||
| FaxNumber: | 9366328832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2012 | ||||||||
| LastUpdateDate: | 12/29/2016 | ||||||||
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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 | 207RC0000X | A119735 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | P3245 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | P3245 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 345631102 | 05 | TX | MEDICAID |