Healthcare Provider Details

I. General information

NPI: 1225099690
Provider Name (Legal Business Name): FARIBA AZARPOUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 VETERANS MEMORIAL PKWY STE 200
SAINT CHARLES MO
63303-2106
US

IV. Provider business mailing address

711 VETERANS MEMORIAL PKWY STE 200
SAINT CHARLES MO
63303-2106
US

V. Phone/Fax

Practice location:
  • Phone: 636-669-2443
  • Fax: 636-669-2390
Mailing address:
  • Phone: 636-669-2243
  • Fax: 636-669-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR1H95
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: