Provider Demographics
NPI:1225099690
Name:AZARPOUR, FARIBA (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:AZARPOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 VETERANS MEMORIAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2106
Mailing Address - Country:US
Mailing Address - Phone:636-669-2243
Mailing Address - Fax:636-669-2390
Practice Address - Street 1:711 VETERANS MEMORIAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2106
Practice Address - Country:US
Practice Address - Phone:636-669-2443
Practice Address - Fax:636-669-2390
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1H95208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209757824Medicaid
MO043010556Medicare ID - Type Unspecified
MO209757824Medicaid