Provider Demographics
NPI:1134104797
Name:PAYDARFAR, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PAYDARFAR
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 1:110 INNER CAMPUS DR STOP K5300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1663
Mailing Address - Country:US
Mailing Address - Phone:512-495-5300
Mailing Address - Fax:512-495-5301
Practice Address - Street 1:1601 TRINITY ST STOP Z0200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1850
Practice Address - Country:US
Practice Address - Phone:513-495-5300
Practice Address - Fax:512-495-5301
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA729372084N0400X
TX457692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110049868AMedicaid
MA3077756Medicaid
MA110049868AMedicaid
MAJ1100401Medicare PIN