Healthcare Provider Details

I. General information

NPI: 1285373985
Provider Name (Legal Business Name): SEIFOLLAH AZADI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 RESEARCH PKWY STE 450A
OKLAHOMA CITY OK
73104-3629
US

IV. Provider business mailing address

755 RESEARCH PKWY STE 450A
OKLAHOMA CITY OK
73104-3629
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-2830
  • Fax:
Mailing address:
  • Phone: 405-822-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number37D2252058
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: