Provider Demographics
NPI:1689754426
Name:GOLZARI, IRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:IRAJ
Middle Name:
Last Name:GOLZARI
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 1:1869 S TAMIAMI TR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293
Mailing Address - Country:US
Mailing Address - Phone:941-497-0377
Mailing Address - Fax:941-497-0278
Practice Address - Street 1:1869 S TAMIAMI TR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-497-0377
Practice Address - Fax:941-497-0278
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046011208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN4296OtherRR MEDICARE
FL2065681OtherAETNA
FL2065681OtherAETNA
FL58458XMedicare ID - Type Unspecified
FL97786Medicare ID - Type Unspecified