Provider Demographics
NPI:1043249808
Name:RAJPUT, FARZAN SHABBIR (MD)
Entity type:Individual
Prefix:
First Name:FARZAN
Middle Name:SHABBIR
Last Name:RAJPUT
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:PO BOX 2716
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0170
Mailing Address - Country:US
Mailing Address - Phone:949-870-6668
Mailing Address - Fax:949-229-6462
Practice Address - Street 1:280 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7526
Practice Address - Country:US
Practice Address - Phone:949-870-6668
Practice Address - Fax:949-229-6462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95017207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A950170OtherBLUE SHIELD OF CA
P00458295OtherRAILROAD MEDICARE
WA95017AMedicare PIN
H02291Medicare UPIN
WA95017BMedicare PIN