Healthcare Provider Details

I. General information

NPI: 1548655343
Provider Name (Legal Business Name): MEHYAR HEFAZI TORGHABEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S GARNETT RD STE 112
TULSA OK
74146-5201
US

IV. Provider business mailing address

4608 NW 135TH CIR
VANCOUVER WA
98685-1567
US

V. Phone/Fax

Practice location:
  • Phone: 972-665-8498
  • Fax:
Mailing address:
  • Phone: 301-281-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28866
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38598
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: