Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 039088 | MA |
Y | 208600000X | Surgeon | 039088 | MA |
N | 2086S0129X | Vascular Surgeon | 039088 | MA |
NPI | 1053374603 |
---|---|
Provider Name | Dr. Morteza Morey Farizan |
First Address | Dorchester Center, MA 02124-5628 |
Second Address | Dorchester Center, MA 02124-5628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 23/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2064863 | (05) | MA |
A66895 | (02) | MA |