Provider Demographics
NPI:1376538678
Name:PAYDAR, FARSHID (MD)
Entity Type:Individual
Prefix:
First Name:FARSHID
Middle Name:
Last Name:PAYDAR
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 4294
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86340-4294
Mailing Address - Country:US
Mailing Address - Phone:928-203-9600
Mailing Address - Fax:928-203-9601
Practice Address - Street 1:401 S CALVARY WAY STE D
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4165
Practice Address - Country:US
Practice Address - Phone:928-649-2600
Practice Address - Fax:928-649-7847
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ438540Medicaid
AZZ111721Medicare PIN
G07553Medicare UPIN