Healthcare Provider Details

I. General information

NPI: 1841678307
Provider Name (Legal Business Name): KAYVEN M FARSHAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 E ROSEWOOD ST STE 110
TUCSON AZ
85710-1346
US

IV. Provider business mailing address

4881 E GRANT RD
TUCSON AZ
85712-2704
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-6035
  • Fax: 520-795-9953
Mailing address:
  • Phone: 520-829-6776
  • Fax: 520-829-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR74993
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR74993
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number59113
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: