1215237573 NPI number — REZA AZAR M.D.,PA

Table of content: (NPI 1215237573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215237573 NPI number — REZA AZAR M.D.,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REZA AZAR M.D.,PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215237573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8720 N KENDALL DR
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-2299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-274-2800
Provider Business Mailing Address Fax Number:
305-459-1941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8720 N KENDALL DR
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-274-2800
Provider Business Practice Location Address Fax Number:
305-459-1941
Provider Enumeration Date:
11/02/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AZAR
Authorized Official First Name:
REZA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-274-2800

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME0027242 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)