Provider Demographics
NPI:1891001400
Name:MORI, SHAHRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:MORI
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 1:3150 N TENAYA WAY STE 520
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0448
Mailing Address - Country:US
Mailing Address - Phone:702-962-2100
Mailing Address - Fax:702-962-5620
Practice Address - Street 1:2415 N ORANGE AVE STE 601
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5558
Practice Address - Country:US
Practice Address - Phone:407-303-2070
Practice Address - Fax:407-303-2071
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72223207R00000X, 207RH0003X
FLME120835207RH0000X, 207RX0202X
CAA124379207RH0003X
NV21041207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology