Provider Demographics
NPI:1235199779
Name:SHIRMOHAMMADI, ZAHRA (MD)
Entity Type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:SHIRMOHAMMADI
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:PO BOX 708850
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8850
Mailing Address - Country:US
Mailing Address - Phone:800-846-5314
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:601 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3670
Practice Address - Country:US
Practice Address - Phone:505-727-8040
Practice Address - Fax:505-727-8086
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20050615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65103254Medicaid
NMI43674Medicare UPIN