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NPI Code Detail

MEDICARE: KOUROSH MEHRAZAR MD

MEDICARE: KOUROSH MEHRAZAR 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
12084P0800XPsychiatry PhysicianMD216738OR

General Provider Information

NPI Number : 1972168219
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOUROSH MEHRAZAR MD
Provider Business Mailing Address
First Line : 2700 NW STEWART PKWY
Second Line :
City : ROSEBURG
State : OR
Zip : 97471-1214
Country : US
Telephone Number : 541-673-0611
Fax Number :
Provider Business Practice Location Address
First Line : 2700 NW STEWART PKWY
Second Line :
City : ROSEBURG
State : OR
Zip : 97471-1214
Country : US
Telephone Number : 541-673-0611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2019
Last Update Date : 03/09/2026

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Directions to “ KOUROSH MEHRAZAR MD” Practice Location

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