MEDICARE: FARSHID FIROOZBAKHT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101241021	VA
2	208M00000X	Hospitalist Physician	017873	ME
3	207R00000X	Internal Medicine Physician	MD60261524	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023159308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARSHID FIROOZBAKHT MD

Provider Business Mailing Address
First Line	:	PO BOX 25608
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84125-0608
Country	:	US
Telephone Number	:	206-320-4476
Fax Number	:	206-568-7042

Provider Business Practice Location Address
First Line	:	945 HILDEBRAND LN NE
Second Line	:	STE 100
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2877
Country	:	US
Telephone Number	:	206-991-2121
Fax Number	:	206-991-2151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	10/07/2020

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