Provider Demographics
NPI:1528097722
Name:FARID, REZA S (MD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:S
Last Name:FARID
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:315 W BUSINESS LOOP 70
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3248
Practice Address - Country:US
Practice Address - Phone:573-884-0033
Practice Address - Fax:573-884-0055
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110906208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO294836OtherHEALTHLINK
MO205205909Medicaid
MO104665OtherBLUE SHIELD/BLUE CHOICE
MO2300073OtherUNITED HEALTHCARE
MO2087226901OtherKANSAS MEDICAID
MO104665OtherBLUE SHIELD/BLUE CHOICE
MO205205909Medicaid
MOP00422528Medicare PIN
MOF75011Medicare UPIN