Provider Demographics
NPI:1023159308
Name:FIROOZBAKHT, FARSHID (MD)
Entity type:Individual
Prefix:
First Name:FARSHID
Middle Name:
Last Name:FIROOZBAKHT
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:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7042
Practice Address - Street 1:945 HILDEBRAND LN NE
Practice Address - Street 2:STE 100
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2877
Practice Address - Country:US
Practice Address - Phone:206-991-2121
Practice Address - Fax:206-991-2151
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241021207R00000X
ME017873208M00000X
WAMD60261524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433007699Medicaid
NH30207966Medicaid
ME433007699Medicaid
G02637I04Medicare PIN
NH30207966Medicaid