Basic Information
| Provider Information | |||||||||
| NPI: | 1003007048 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEREIDOUNI | ||||||||
| FirstName: | SAM | ||||||||
| MiddleName: | SAMAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7699 E PINNACLE PEAK RD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852556322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803004663 | ||||||||
| FaxNumber: | 4803004888 | ||||||||
| Practice Location | |||||||||
| Address1: | 7699 E PINNACLE PEAK RD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852556322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803004663 | ||||||||
| FaxNumber: | 4803004888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0066324 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 37515 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.