Provider Demographics
NPI:1295726750
Name:DAGHER, AZAR P (MD)
Entity type:Individual
Prefix:DR
First Name:AZAR
Middle Name:P
Last Name:DAGHER
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 1:1150 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2137
Mailing Address - Country:US
Mailing Address - Phone:305-243-1576
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2137
Practice Address - Country:US
Practice Address - Phone:305-243-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1515092085N0700X, 2085R0202X
MDD00430482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD126591100Medicaid
DC055005700Medicaid
MD2622593OtherAETNA HMO/POS
MDC041OtherAAD SHIPLEYS
MD10690024OtherBCBS
MD02OtherAAD PG COUNTY
MD8317071OtherAETNA PPO
MDB976OtherAAD AA COUNTY
MD300123380Medicare PIN
MD8317071OtherAETNA PPO
MDF79226Medicare UPIN
MDS629A202Medicare ID - Type Unspecified
MD10690024OtherBCBS