Healthcare Provider Details

I. General information

NPI: 1396774139
Provider Name (Legal Business Name): SHAHRAM ABBASSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

PO BOX 725
BAYSIDE CA
95524-0725
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-3621
  • Fax: 707-633-6086
Mailing address:
  • Phone: 707-822-7220
  • Fax: 707-633-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA51286
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA51286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: