Provider Demographics
NPI:1093703944
Name:GOLZARIAN, JAFAR (MD)
Entity Type:Individual
Prefix:
First Name:JAFAR
Middle Name:
Last Name:GOLZARIAN
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:PO BOX 860856
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0856
Mailing Address - Country:US
Mailing Address - Phone:952-960-9399
Mailing Address - Fax:952-206-6467
Practice Address - Street 1:8401 GOLDEN VALLEY RD STE 340
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4488
Practice Address - Country:US
Practice Address - Phone:952-960-9399
Practice Address - Fax:952-206-6467
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN505062085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291195Medicaid
IA33814OtherWELLMARK BCBS
H82992Medicare UPIN
IA0291195Medicaid
IAP00010013Medicare PIN