Provider Demographics
NPI:1548655343
Name:HEFAZI TORGHABEH, MEHYAR
Entity type:Individual
Prefix:
First Name:MEHYAR
Middle Name:
Last Name:HEFAZI TORGHABEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 NW 135TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1567
Mailing Address - Country:US
Mailing Address - Phone:301-281-1033
Mailing Address - Fax:
Practice Address - Street 1:4500 S GARNETT RD STE 112
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5201
Practice Address - Country:US
Practice Address - Phone:972-665-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS288662085R0202X
390200000X
OK385982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program