Provider Demographics
NPI:1366685794
Name:ESKANDARI, FARZAN (MD)
Entity Type:Individual
Prefix:
First Name:FARZAN
Middle Name:
Last Name:ESKANDARI
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 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:417-623-6330
Mailing Address - Fax:
Practice Address - Street 1:1801 W 32ND ST STE B101
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1515
Practice Address - Country:US
Practice Address - Phone:417-623-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015022432207ZP0102X
WI62304207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200598970AMedicaid
MO1366685794Medicaid
MOP01513925OtherRAIL ROAD MEDICARE
KS201119500AMedicaid
MO1366685794Medicaid