Basic Information
| Provider Information | |||||||||
| NPI: | 1023219987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AZAR | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AZAR | ||||||||
| OtherFirstName: | JOSEPH | ||||||||
| OtherMiddleName: | KHALIL | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | II | ||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19020 33RD AVE W STE 210 | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255631500 | ||||||||
| FaxNumber: | 4255631374 | ||||||||
| Practice Location | |||||||||
| Address1: | 4816 NE THURSTON WAY STE A | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986626661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602544914 | ||||||||
| FaxNumber: | 3604494987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD60087796 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD28118 | OR | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085B0100X | MD60087796 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
ID Information
| ID | Type | State | Issuer | Description | 0423970 | 01 | WA | L&I-RADIA-REST OF WA | OTHER | 0423976 | 01 | WA | L&I-SEATTLE RADIOLOGY | OTHER | 0423972 | 01 | WA | L&I-SWEDISH RADIA EDMONDS | OTHER | 218640 | 05 | OR | MEDICAID | 0423971 | 01 | WA | L&I-RADIA-KING | OTHER | 0423975 | 01 | WA | L&I-SOUTH SOUND RADIOLOGY | OTHER | 0423974 | 01 | WA | L&I-EVERGREEN RADIA | OTHER | 1088366 | 05 | WA | MEDICAID |