Healthcare Provider Details

I. General information

NPI: 1801710504
Provider Name (Legal Business Name): FARSHID PAYDAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 WILLOW CREEK RD STE 103
PRESCOTT AZ
86301-1619
US

IV. Provider business mailing address

401 S CALVARY WAY STE D
COTTONWOOD AZ
86326-4165
US

V. Phone/Fax

Practice location:
  • Phone: 928-649-2600
  • Fax: 928-634-7847
Mailing address:
  • Phone: 928-649-2600
  • Fax: 928-634-7847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FARSHID PAYDAR
Title or Position: AO, PRESIDENT
Credential: MD
Phone: 928-649-2600