Provider Demographics
NPI:1841771904
Name:AFSHAR, FARZAM
Entity Type:Individual
Prefix:DR
First Name:FARZAM
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 POST OAK BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3973
Mailing Address - Country:US
Mailing Address - Phone:713-529-9355
Mailing Address - Fax:
Practice Address - Street 1:1700 POST OAK BLVD STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3973
Practice Address - Country:US
Practice Address - Phone:713-529-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-1879207Q00000X
VT099.0134059207Q00000X
CA1007208D00000X
WANT60892302208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine