1649306523 NPI number — JAMSHID MIRZAEI MD

Table of content: JAMSHID MIRZAEI MD (NPI 1649306523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649306523 NPI number — JAMSHID MIRZAEI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRZAEI
Provider First Name:
JAMSHID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRZAEI
Provider Other First Name:
JAMSHID
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649306523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 202378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80220-8378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-999-8179
Provider Business Mailing Address Fax Number:
702-453-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5880 S HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLOBE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85501-9447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-999-8179
Provider Business Practice Location Address Fax Number:
702-453-5741
Provider Enumeration Date:
02/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  DR.0049409 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD60036851 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: DR.0049409 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00201057 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01378874 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".