Healthcare Provider Details

I. General information

NPI: 1619102951
Provider Name (Legal Business Name): ARVIN N BAGHERPOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10835 N 25TH AVE SUITE 240
PHOENIX AZ
85029-4751
US

IV. Provider business mailing address

10835 N 25TH AVE SUITE 240
PHOENIX AZ
85029-4751
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-2584
  • Fax: 602-246-2566
Mailing address:
  • Phone: 602-246-2584
  • Fax: 602-246-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28627
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number42714
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number28627
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number42714
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: