Abolghasem Rezaei MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23655 Issued in OK

Legal business name

ABOLGHASEM REZAEI MD PC

Practice address

4121 W Gore Blvd
Lawton, OK 73505-6336

Phone

(580) 699-5511

Fax

(580) 699-5519

NPI assigned

Oct 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Abolghasem Marco Rezaei, MD

Title

Owner

Phone

(580) 699-5511

Specialties & licenses 1

Addresses

Other names 1

• Family Medicine & Urgent Care Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616803200000",
    "number": "1366538183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056336",
            "telephone_number": "580-699-5511",
            "fax_number": "580-995-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056336",
            "telephone_number": "580-699-5511",
            "fax_number": "580-699-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABOLGHASEM REZAEI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2021-03-27",
        "certification_date": "2021-03-27",
        "status": "A",
        "authorized_official_last_name": "REZAEI",
        "authorized_official_first_name": "ABOLGHASEM",
        "authorized_official_middle_name": "MARCO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-699-5511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "23655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine & Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Lawton, OK
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.