Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 37515 | AZ |
N | 207Q00000X | Family Doctor | D0066324 | MD |
NPI | 1003007048 |
---|---|
Provider Name | Dr. Sam Saman Fereidouni |
First Address | Scottsdale, AZ 85255-6322 |
Second Address | Scottsdale, AZ 85255-6322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 26/01/2017 |