Provider Demographics
NPI:1194713263
Name:JAVADPOOR, SEYED AHMED (MD)
Entity type:Individual
Prefix:
First Name:SEYED
Middle Name:AHMED
Last Name:JAVADPOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 E SOUTHERN AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5519
Mailing Address - Country:US
Mailing Address - Phone:480-325-8173
Mailing Address - Fax:480-325-8179
Practice Address - Street 1:3155 E SOUTHERN AVE
Practice Address - Street 2:STE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5519
Practice Address - Country:US
Practice Address - Phone:480-325-8173
Practice Address - Fax:480-325-8179
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31527207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ789539Medicaid
AZZ78326Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
AZH24836Medicare UPIN
AZ789539Medicaid