Healthcare Provider Details

I. General information

NPI: 1801092465
Provider Name (Legal Business Name): MEHDY YAVARI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 45TH ST
WEST PALM BEACH FL
33407-2047
US

IV. Provider business mailing address

2201 45TH ST
WEST PALM BEACH FL
33407-2047
US

V. Phone/Fax

Practice location:
  • Phone: 561-863-3901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT011957
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A11847
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS11235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: