Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD61000908 | WA |
N | 207XS0117X | Orthopaedic Spine Surgeon | 14668 | AL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME145684 | FL |
NPI | 1023063989 |
---|---|
Provider Name | Dr. Cyrus Ghavam |
First Address | Boca Raton, FL 33431-6464 |
Second Address | Delray Beach, FL 33484-6537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009937579 | (05) | AL |
2149403 | (05) | WA |
4520495 | AETNA (01) | AL |
51535248 | BCBS (01) | AL |
E29408 | (02) | |
P00338937 | RAILROAD MEDICARE (01) | AL |