Healthcare Provider Details

I. General information

NPI: 1710542667
Provider Name (Legal Business Name): AZHAR BASHIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11958 W BROAD ST
RICHMOND VA
23233-1007
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-9734
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-4669
  • Fax: 804-828-4762
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD61526149
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD61526149
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101285323
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0101285323
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: