Healthcare Provider Details

I. General information

NPI: 1467806356
Provider Name (Legal Business Name): MASOUD ASGARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 NORRIS CANYON RD
SAN RAMON CA
94583-5400
US

IV. Provider business mailing address

PO BOX 576730
MODESTO CA
95357-6730
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-1200
  • Fax:
Mailing address:
  • Phone: 209-577-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2016-00560
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA151460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: