Healthcare Provider Details

I. General information

NPI: 1144211137
Provider Name (Legal Business Name): DAVID M. VAZIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ROUTE 664 N
LOGAN OH
43138-8541
US

IV. Provider business mailing address

601 STATE ROUTE 664 N
LOGAN OH
43138-8541
US

V. Phone/Fax

Practice location:
  • Phone: 740-380-8140
  • Fax:
Mailing address:
  • Phone: 740-380-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-06-6496
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: