Provider Demographics
NPI:1083659338
Name:KARBASSI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:KARBASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:205 S MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1716
Mailing Address - Country:US
Mailing Address - Phone:303-772-3611
Mailing Address - Fax:303-772-3609
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1716
Practice Address - Country:US
Practice Address - Phone:303-772-3611
Practice Address - Fax:303-772-3609
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44707207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KAM4707OtherANTHEM BS
CO931468OtherEYE SPECIALISTS
5476659OtherAETNA
CO841353910OtherTOTAL LONG TERM CARE
SS#841353910OtherVSP
CO44707OtherMEDICAL LICENSE
CO841353910002OtherROCKY MOUNTAIN HMO
5476659OtherAETNA
CO931468OtherEYE SPECIALISTS