Provider Demographics
NPI:1043560261
Name:PACIFIC-FIRE MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:PACIFIC-FIRE MEDICAL SERVICES PLLC
Other - Org Name:AZAR SADEGHALVAD, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHALVAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-542-1517
Mailing Address - Street 1:1207 N 200TH ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-542-1517
Mailing Address - Fax:206-542-2317
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:SUITE 217
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-542-1517
Practice Address - Fax:206-542-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60281918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty