Provider Demographics
NPI:1649273814
Name:SARRAF, PAYAM (DPM)
Entity type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:SARRAF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 E BASELINE RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2965
Mailing Address - Country:US
Mailing Address - Phone:480-812-3668
Mailing Address - Fax:480-782-1290
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:SUITE 121
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2965
Practice Address - Country:US
Practice Address - Phone:480-812-3668
Practice Address - Fax:480-782-1290
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0574213ES0103X
CAE4366213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU96409Medicare UPIN
AZ116351Medicare PIN