Provider Demographics
NPI:1033485404
Name:SAFAROV, RUSLAN (MD)
Entity Type:Individual
Prefix:
First Name:RUSLAN
Middle Name:
Last Name:SAFAROV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W MORRIS BLVD STE 400D
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2282
Mailing Address - Country:US
Mailing Address - Phone:423-586-7501
Mailing Address - Fax:
Practice Address - Street 1:420 W MORRIS BLVD STE 400D
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2282
Practice Address - Country:US
Practice Address - Phone:423-586-7509
Practice Address - Fax:423-581-5701
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31386207XX0005X
IAMD-45407207XX0005X
FLME149074207XX0005X
TNMD0000063618207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine