Provider Demographics
NPI:1144329038
Name:MEMON, PARVEZ RAZZAQUE (MD)
Entity type:Individual
Prefix:
First Name:PARVEZ
Middle Name:RAZZAQUE
Last Name:MEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 SAN DIMAS ST
Mailing Address - Street 2:BUILDING B SUITE 111
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2284
Mailing Address - Country:US
Mailing Address - Phone:661-616-1030
Mailing Address - Fax:661-616-3237
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:BUILDING B SUITE 111
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2284
Practice Address - Country:US
Practice Address - Phone:661-616-1030
Practice Address - Fax:661-716-5484
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66640207RG0300X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87669Medicare UPIN
CAOOA066640Medicare ID - Type Unspecified