Provider Demographics
NPI:1730131855
Name:AZADPOUR, MAZIAR (MD)
Entity Type:Individual
Prefix:
First Name:MAZIAR
Middle Name:
Last Name:AZADPOUR
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 1:777 COMMERCIAL ST SE
Mailing Address - Street 2:130
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3421
Mailing Address - Country:US
Mailing Address - Phone:503-798-9306
Mailing Address - Fax:503-485-4789
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 5080
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-485-4787
Practice Address - Fax:503-485-4789
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD26734207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005969Medicaid
OR831646004OtherBCBS
ORP00359745OtherRAILROAD MEDICARE
OR831646004OtherBCBS
OR005969Medicaid