Provider Demographics
NPI:1700853801
Name:TOHIDI, BEHROOZ (MD)
Entity Type:Individual
Prefix:
First Name:BEHROOZ
Middle Name:
Last Name:TOHIDI
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 1:5606 SW LEE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9663
Mailing Address - Country:US
Mailing Address - Phone:580-531-6476
Mailing Address - Fax:580-531-6491
Practice Address - Street 1:5604 SW LEE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9663
Practice Address - Country:US
Practice Address - Phone:580-531-6476
Practice Address - Fax:580-531-6491
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021288207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
W13567Medicare ID - Type Unspecified
A29116Medicare UPIN