Provider Demographics
NPI:1932300472
Name:AZADI, REZA JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:JOHN
Last Name:AZADI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8001
Practice Address - Street 1:6465 S YALE AVE STE 804
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7810
Practice Address - Country:US
Practice Address - Phone:918-502-3550
Practice Address - Fax:918-502-3555
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4270207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200181090AMedicaid
OKOK402840Medicare PIN