Provider Demographics
NPI:1417356775
Name:SAFAR, SINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SINA
Middle Name:
Last Name:SAFAR
Suffix:
Gender:M
Credentials:DPM
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 308
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1806
Mailing Address - Country:US
Mailing Address - Phone:480-718-5400
Mailing Address - Fax:877-666-4624
Practice Address - Street 1:1840 E BASELINE RD STE A1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1527
Practice Address - Country:US
Practice Address - Phone:480-718-5400
Practice Address - Fax:877-666-4624
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00329100213E00000X, 213ES0103X
AZPOD-000877213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery