Healthcare Provider Details

I. General information

NPI: 1437322898
Provider Name (Legal Business Name): OMID JAZAERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

7780 S BROADWAY STE 260
LITTLETON CO
80122-2633
US

V. Phone/Fax

Practice location:
  • Phone: 572-244-0074
  • Fax: 572-244-9882
Mailing address:
  • Phone: 720-330-1300
  • Fax: 720-452-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number48825
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number47771
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: