Provider Demographics
NPI:1588866354
Name:FARIVAR, ROBERT SAEID (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAEID
Last Name:FARIVAR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:
Practice Address - Street 1:6140 W CURTISIAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0109
Practice Address - Country:US
Practice Address - Phone:208-302-0130
Practice Address - Fax:208-302-0135
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57549208G00000X
IDM-15527208G00000X
MA203484208600000X, 208G00000X
FL134669208G00000X
IA37778208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0104574Medicaid
IAP00694372Medicare PIN
IAI0923048Medicare PIN
MAH17175Medicare UPIN
MA0104574Medicaid