Provider Demographics
NPI:1265655153
Name:VAHABZADEH, BABAC (MD)
Entity Type:Individual
Prefix:DR
First Name:BABAC
Middle Name:
Last Name:VAHABZADEH
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 1:10103 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5520
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:303-790-2567
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 312
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:303-790-2567
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005018189207R00000X
KS04-33302207R00000X
TNMD48449207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110426018Medicare PIN