Basic Information
| Provider Information | |||||||||
| NPI: | 1336138262 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARZIN | ||||||||
| FirstName: | BERNARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98978 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 9499 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891177150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022285477 | ||||||||
| FaxNumber: | 7022557981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 10/12/2015 | ||||||||
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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 | D0055075 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 6861 | AK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 13691 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5704 | 01 | DC | CAREFIRST DC | OTHER | OF31 BR | 01 | MD | CAREFIRST MD | OTHER | 102355 | 01 | MD | AETNA | OTHER | MD9996 | 05 | AK | MEDICAID | 080146251 | 01 | MD | RR/MEDICARE | OTHER | 162616 | 01 | AK | MEDICARE GROUP ID | OTHER | DS6541 | 01 | AK | RAILROAD MEDICARE GROUP # | OTHER | 2099063 00 | 05 | MD | MEDICAID | 889382 | 01 | MD | MAMSI | OTHER | MDG046 | 01 | AK | MEDICAID GROUP # | OTHER | P01051151 | 01 | AK | RAILROAD MEDICARE PIN | OTHER |