MEDICARE: DR. PAYAM SARRAF D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0574	AZ
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E4366	CA

General Provider Information

NPI Number	:	1649273814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAYAM SARRAF D.P.M.

Provider Business Mailing Address
First Line	:	4915 E BASELINE RD
Second Line	:	SUITE 121
City	:	GILBERT
State	:	AZ
Zip	:	85234-2965
Country	:	US
Telephone Number	:	480-812-3668
Fax Number	:	480-782-1290

Provider Business Practice Location Address
First Line	:	4915 E BASELINE RD
Second Line	:	SUITE 121
City	:	GILBERT
State	:	AZ
Zip	:	85234-2965
Country	:	US
Telephone Number	:	480-812-3668
Fax Number	:	480-782-1290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/31/2008

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