1205082898 NPI number — MORTEZA MONTAZERI,M.D.INC

Table of content: (NPI 1205082898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205082898 NPI number — MORTEZA MONTAZERI,M.D.INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORTEZA MONTAZERI,M.D.INC
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:
1205082898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 SW 38TH ST
Provider Second Line Business Mailing Address:
SUITE#A
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73505-7013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-357-6700
Provider Business Mailing Address Fax Number:
580-357-9912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 SW 38TH ST
Provider Second Line Business Practice Location Address:
SUITE#A
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73505-7013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-357-6700
Provider Business Practice Location Address Fax Number:
580-357-9912
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MONTAZERI
Authorized Official First Name:
MORTEZA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
580-357-6700

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  13452 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com