Provider Demographics
NPI:1033352968
Name:ANISSIPOUR, ALIREZA K (DO)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:K
Last Name:ANISSIPOUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1728 W MARINE VIEW DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2094
Mailing Address - Country:US
Mailing Address - Phone:425-259-4041
Mailing Address - Fax:
Practice Address - Street 1:3726 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3787
Practice Address - Country:US
Practice Address - Phone:425-317-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60435741207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1033352968Medicaid
WA1033352968Medicaid