Healthcare Provider Details

I. General information

NPI: 1215237573
Provider Name (Legal Business Name): REZA AZAR M.D.,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 N KENDALL DR SUITE 214
MIAMI FL
33176-2299
US

IV. Provider business mailing address

8720 N KENDALL DR SUITE 214
MIAMI FL
33176-2299
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-2800
  • Fax: 305-459-1941
Mailing address:
  • Phone: 305-274-2800
  • Fax: 305-459-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0027242
License Number StateFL

VIII. Authorized Official

Name: DR. REZA AZAR
Title or Position: OWNER
Credential: M.D.
Phone: 305-274-2800