Provider Demographics
NPI:1881705945
Name:REZA ESFAHANI, D.O., P.C.
Entity type:Organization
Organization Name:REZA ESFAHANI, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ESFAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-220-5707
Mailing Address - Street 1:PO BOX 4277
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80155-4277
Mailing Address - Country:US
Mailing Address - Phone:303-220-5707
Mailing Address - Fax:
Practice Address - Street 1:6161 S SYRACUSE WAY
Practice Address - Street 2:SUITE 310
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4707
Practice Address - Country:US
Practice Address - Phone:303-220-5707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59379006Medicaid