Provider Demographics
NPI:1972500981
Name:YAZDI, JOSEPH S (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:YAZDI
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 1:1034 S BRENTWOOD BLVD STE 754
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1207
Mailing Address - Country:US
Mailing Address - Phone:314-973-2955
Mailing Address - Fax:833-244-1845
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 754
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1207
Practice Address - Country:US
Practice Address - Phone:314-739-2955
Practice Address - Fax:833-244-1845
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014039596207T00000X
OH35079732Y207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38839Medicare UPIN