Provider Demographics
NPI:1225123862
Name:SHAHVAR, PARVIZ (PC)
Entity Type:Individual
Prefix:
First Name:PARVIZ
Middle Name:
Last Name:SHAHVAR
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E. MC DOWELL RD.
Mailing Address - Street 2:#101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2607
Mailing Address - Country:US
Mailing Address - Phone:602-258-6776
Mailing Address - Fax:602-258-6788
Practice Address - Street 1:1010 E. MC DOWELL RD.
Practice Address - Street 2:#101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2607
Practice Address - Country:US
Practice Address - Phone:602-258-6776
Practice Address - Fax:602-258-6788
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF38712Medicare UPIN
AZZ82772Medicare PIN