Healthcare Provider Details

I. General information

NPI: 1457770901
Provider Name (Legal Business Name): FARHOOD FIROUZBAKHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

462 GRIDER ST DK MILLER BUILDING
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-8040
  • Fax: 719-776-8050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0059791
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0059791
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: