Provider Demographics
NPI:1326701061
Name:ARSHADI, KHASHAYAR JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:KHASHAYAR
Middle Name:JOHN
Last Name:ARSHADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ARSHADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15903 KENT CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1402
Mailing Address - Country:US
Mailing Address - Phone:419-967-6767
Mailing Address - Fax:909-206-0538
Practice Address - Street 1:3535 S JEFFERSON AVE STE 314
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3935
Practice Address - Country:US
Practice Address - Phone:314-772-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021036981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty