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General NPI Number Information
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NPI Number | 1528311123
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Entity Type | Organization
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Legal Business Name | FARNAZ DANA FAKHARI, MD, PC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 18380 WILLAMETTE DR STE 201
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City | WEST LINN
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State | OR
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Zip | 97068-1200
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Country | US
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Telephone | 503-344-6487
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Fax | 503-972-1689
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Provider Business Mailing Address
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Address Line | 18380 WILLAMETTE DR STE 201
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City | WEST LINN
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State | OR
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Zip | 97068-1200
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Country | US
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Telephone | 503-344-6487
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Fax | 503-972-1689
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Authorized Official
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Title or Position | PHYSICIAN PROVIDER/PRESIDENT
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Name | FARNAZ DANA FAKHARI
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Credential | MD
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Telephone | 503-344-6487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD157343
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License Number State | OR
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