Provider Demographics
NPI:1881996395
Name:ALI REZA ZARGARAN , M.D,P.A.
Entity type:Organization
Organization Name:ALI REZA ZARGARAN , M.D,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:ZARGARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:954-942-8987
Mailing Address - Street 1:2701 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4941
Mailing Address - Country:US
Mailing Address - Phone:954-942-8987
Mailing Address - Fax:954-942-9545
Practice Address - Street 1:2701 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4941
Practice Address - Country:US
Practice Address - Phone:954-942-8987
Practice Address - Fax:954-942-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66452261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376166500Medicaid
FL25762OtherMEDICARE ID-TYPE
FLF89114Medicare UPIN