Provider Demographics
NPI:1114122876
Name:PANAH, SIAVASH (MD)
Entity Type:Individual
Prefix:
First Name:SIAVASH
Middle Name:
Last Name:PANAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIAVASH
Other - Middle Name:
Other - Last Name:FARSHIDPANAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5199
Mailing Address - Country:US
Mailing Address - Phone:970-810-2026
Mailing Address - Fax:970-810-2028
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5199
Practice Address - Country:US
Practice Address - Phone:951-486-4000
Practice Address - Fax:951-486-5705
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111488207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
CODR.0062745207RC0200X, 207RP1001X, 207RS0012X
TN26932084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA123699OtherPTAN