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General NPI Number Information
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NPI Number | 1841258365
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Entity Type | Individual
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Provider Name | SHAHRIAR ANOUSHFAR D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 612 N 13TH ST
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City | ARTESIA
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State | NM
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Zip | 88210-1112
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Country | US
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Telephone | 575-748-8526
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Fax | 575-748-8575
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Provider Business Mailing Address
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Address Line | PO BOX 629
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City | ARTESIA
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State | NM
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Zip | 88211-0629
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Country | US
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Telephone | 575-736-8262
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Fax | 575-748-8305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 11022
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License Number State | MT
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