Provider Demographics
NPI:1558439539
Name:AZIZEH ASGARI MD
Entity Type:Organization
Organization Name:AZIZEH ASGARI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-338-3135
Mailing Address - Street 1:PO BOX 1224
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-1224
Mailing Address - Country:US
Mailing Address - Phone:580-338-3135
Mailing Address - Fax:580-338-3137
Practice Address - Street 1:421 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3640
Practice Address - Country:US
Practice Address - Phone:580-338-3135
Practice Address - Fax:580-338-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27528207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489890Medicaid
CA954774889OtherUNITED HEALTHCARE
CA00A489891Medicaid
OK200271700AMedicaid
CA954774889OtherBLUE CROSS
E70707Medicare UPIN
CA00A489890Medicaid
W17243Medicare PIN