Provider Demographics
NPI:1336138262
Name:FARZIN, BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:FARZIN
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:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9499 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7150
Practice Address - Country:US
Practice Address - Phone:702-228-5477
Practice Address - Fax:702-255-7981
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055075207Q00000X
AK6861207Q00000X
NV13691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5704OtherCAREFIRST DC
MDOF31 BROtherCAREFIRST MD
MD102355OtherAETNA
AKMD9996Medicaid
MD080146251OtherRR/MEDICARE
AK162616OtherMEDICARE GROUP ID
AKDS6541OtherRAILROAD MEDICARE GROUP #
MD2099063 00Medicaid
MD889382OtherMAMSI
AKMDG046OtherMEDICAID GROUP #
AKP01051151OtherRAILROAD MEDICARE PIN
MD102355OtherAETNA
MD889382OtherMAMSI
AKMD9996Medicaid