Provider Demographics
NPI:1578574232
Name:MOVAHED SHARIAT PANAHI, MOHAMMAD REZA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD REZA
Middle Name:
Last Name:MOVAHED SHARIAT PANAHI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:MOHAMMAD REZA
Other - Middle Name:
Other - Last Name:MOVAHED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6119 N PINCHOT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1297
Mailing Address - Country:US
Mailing Address - Phone:520-303-4572
Mailing Address - Fax:520-303-4572
Practice Address - Street 1:1 MERCADO ST STE 2020
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-247-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0057483207RI0011X
AZ35065207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ098905Medicaid
AZP00326371OtherRAILROAD MEDICARE
AZ098905Medicaid
H24182Medicare UPIN