Basic Information
Provider Information
NPI: 1003007048
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FEREIDOUNI
FirstName: SAM
MiddleName: SAMAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X37515AZY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XD0066324MDN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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