Provider Demographics
NPI:1518915685
Name:ZAMANI, PAYAM (MD)
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:ZAMANI
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 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2616
Mailing Address - Country:US
Mailing Address - Phone:480-305-2888
Mailing Address - Fax:480-305-2889
Practice Address - Street 1:287 E HUNT HWY
Practice Address - Street 2:SUITE #105
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5096
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-535-0962
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1518915685OtherMEDICARE- NPI
AZ6035350001OtherDME
AZ985541Medicaid
I44126Medicare UPIN
AZ6035350001OtherDME