Provider Demographics
NPI:1295050110
Name:TORAB PARHIZ, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:TORAB PARHIZ
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 1:535 W WATER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 N CURTIS RD STE 302
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1341
Practice Address - Country:US
Practice Address - Phone:812-424-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077110A207W00000X
IDM-14161207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN838920004OtherMEDICARE INDIANA
IN201372370Medicaid