Provider Demographics
NPI:1710282660
Name:RAZA, AMIR (PA)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:RAZA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:AMIR
Other - Middle Name:RAZA
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14108 SMITHURST RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7250
Mailing Address - Country:US
Mailing Address - Phone:405-478-2502
Mailing Address - Fax:
Practice Address - Street 1:925 NE 13TH STREET,
Practice Address - Street 2:CHO 2MR2000D,
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5068
Practice Address - Country:US
Practice Address - Phone:405-271-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1995363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical