Basic Information
| Provider Information | |||||||||
| NPI: | 1033698899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IRANMANESH | ||||||||
| FirstName: | POUYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6431 FANNIN ST STE 4.152B | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007246 | ||||||||
| FaxNumber: | 7133833708 | ||||||||
| Practice Location | |||||||||
| Address1: | 6700 WEST LOOP S STE 500 | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138925500 | ||||||||
| FaxNumber: | 7138710081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2018 | ||||||||
| LastUpdateDate: | 08/12/2018 | ||||||||
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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 | 208600000X | BP10065078 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.