Provider Demographics
NPI:1720311194
Name:ZAREZADEH MEHRIZI, MASOUD
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:ZAREZADEH MEHRIZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 ORCHARD PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9206
Mailing Address - Country:US
Mailing Address - Phone:303-643-1159
Mailing Address - Fax:720-874-5886
Practice Address - Street 1:13701 E MISSISSIPPI AVE STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3697
Practice Address - Country:US
Practice Address - Phone:303-398-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
CODR.0055127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program