Provider Demographics
NPI:1619063799
Name:MIR, HAMID R (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:R
Last Name:MIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAMID
Other - Middle Name:R
Other - Last Name:MIRALIAKBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9131
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9131
Mailing Address - Country:US
Mailing Address - Phone:949-988-7848
Mailing Address - Fax:949-988-7801
Practice Address - Street 1:3501 JAMBOREE RD
Practice Address - Street 2:SUITE 1250
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2939
Practice Address - Country:US
Practice Address - Phone:949-988-7848
Practice Address - Fax:949-988-7801
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84242207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17929Medicare ID - Type UnspecifiedMEDICARE #