Provider Demographics
NPI:1649306523
Name:MIRZAEI, JAMSHID (MD)
Entity type:Individual
Prefix:
First Name:JAMSHID
Middle Name:
Last Name:MIRZAEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMSHID
Other - Middle Name:
Other - Last Name:MIRZAEI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 202378
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-8378
Mailing Address - Country:US
Mailing Address - Phone:303-999-8179
Mailing Address - Fax:702-453-5741
Practice Address - Street 1:5880 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9447
Practice Address - Country:US
Practice Address - Phone:303-999-8179
Practice Address - Fax:702-453-5741
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0049409207R00000X, 208M00000X
WAMD60036851208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00201057Medicaid
COP01378874OtherRAIL ROAD MEDICARE
WAG8908721Medicare PIN
CO326457YL2GMedicare PIN
CO00201057Medicaid
AZZ140920Medicare PIN