Provider Demographics
NPI:1518956119
Name:HIDAJI, FARAMARZ FRED (MD)
Entity Type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:FRED
Last Name:HIDAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:F
Other - Middle Name:FRED
Other - Last Name:HIDAHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6252 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4713
Mailing Address - Country:US
Mailing Address - Phone:901-754-3937
Mailing Address - Fax:901-680-7771
Practice Address - Street 1:6252 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4713
Practice Address - Country:US
Practice Address - Phone:901-754-3937
Practice Address - Fax:901-680-7771
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000034186207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3854721Medicaid
TN119315Medicaid
TN3854724Medicaid
AR158706001Medicaid
AR158706001Medicaid
TN3854724Medicare PIN
TN119315Medicaid