Healthcare Provider Details

I. General information

NPI: 1275629990
Provider Name (Legal Business Name): AZIZ JOHN YAZDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7804
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 719-590-1005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberDR.0035668
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: