Provider Demographics
NPI:1811961204
Name:AFRASIABI, RAHMAT (MD)
Entity type:Individual
Prefix:
First Name:RAHMAT
Middle Name:
Last Name:AFRASIABI
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 1:3130 STILLWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7199
Mailing Address - Country:US
Mailing Address - Phone:928-244-7540
Mailing Address - Fax:928-237-5090
Practice Address - Street 1:3130 STILLWATER DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7199
Practice Address - Country:US
Practice Address - Phone:928-244-7540
Practice Address - Fax:928-237-5090
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45530174400000X, 207KA0200X
AZ51566174400000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ124053OtherMEDICAID
CA00A455300Medicaid
AZZ188722OtherPTAN
AZZ188722OtherPTAN
AZ124053OtherMEDICAID