Healthcare Provider Details

I. General information

NPI: 1114948353
Provider Name (Legal Business Name): FARHAN TAGHIZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 N 16TH ST FL 3
PHOENIX AZ
85016-5189
US

IV. Provider business mailing address

4602 N 16TH ST FL 3
PHOENIX AZ
85016-5189
US

V. Phone/Fax

Practice location:
  • Phone: 480-296-0488
  • Fax: 800-726-5029
Mailing address:
  • Phone: 480-296-0488
  • Fax: 800-726-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2005-0527
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number36688
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number36688
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: