Provider Demographics
NPI:1821085119
Name:PIROUZKAR, BEHROUZ (MD)
Entity Type:Individual
Prefix:
First Name:BEHROUZ
Middle Name:
Last Name:PIROUZKAR
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 1:10212 5TH AVE NE STE 230
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7495
Mailing Address - Country:US
Mailing Address - Phone:206-363-2688
Mailing Address - Fax:
Practice Address - Street 1:10212 5TH AVE NE STE 230
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7495
Practice Address - Country:US
Practice Address - Phone:206-363-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-01
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037233207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1108497Medicaid
WA1108497Medicaid
WAGAB33096Medicare PIN