Provider Demographics
NPI:1578509170
Name:KADIVAR, ARYAN PARKER (MD)
Entity Type:Individual
Prefix:DR
First Name:ARYAN
Middle Name:PARKER
Last Name:KADIVAR
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 1:916 SW 38TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7005
Mailing Address - Country:US
Mailing Address - Phone:580-699-7699
Mailing Address - Fax:580-699-7698
Practice Address - Street 1:916 SW 38TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7005
Practice Address - Country:US
Practice Address - Phone:580-699-7699
Practice Address - Fax:580-699-7698
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200095950AMedicaid
OK200095950AMedicaid