Provider Demographics
NPI:1649375437
Name:SALMASI, SHAHROKH NMN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHROKH
Middle Name:NMN
Last Name:SALMASI
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:P.O. BOX 1472
Mailing Address - Street 2:
Mailing Address - City:BAGDAD
Mailing Address - State:AZ
Mailing Address - Zip Code:86321-1472
Mailing Address - Country:US
Mailing Address - Phone:928-633-6011
Mailing Address - Fax:928-633-3376
Practice Address - Street 1:12 HOPE DRIVE
Practice Address - Street 2:
Practice Address - City:BAGDAD
Practice Address - State:AZ
Practice Address - Zip Code:86321
Practice Address - Country:US
Practice Address - Phone:928-633-6011
Practice Address - Fax:928-633-3376
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19960208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000202464502OtherUNITED HEALTH CARE
AZ055089Medicaid
AZ055089Medicaid
AZAZ1783162OtherDEA
0000202464502OtherUNITED HEALTH CARE