Modarresifar, Homayoun
Modarresifar, Homayoun is an individual health care provider with primary practice located at 2109 W Market St Ste 122 Etsu, Innovation Laboratory, Johnson City TN 37604-6024. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Nuclear Medicine, Allopathic & Osteopathic Physicians / Nuclear Imaging & Therapy. Allopathic & Osteopathic Physicians / Nuclear Imaging & Therapy is his primary health care specialty. Modarresifar, Homayoun can be contacted via phone (423) 439-8000.Contact Information
Primary practice address
2109 W Market St Ste 122 Etsu, Innovation Laboratory
Johnson City TN 37604-6024
Phone: (423) 439-8000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nuclear Medicine | 207U00000X | 41198 | Arizona |
| Allopathic & Osteopathic Physicians / Nuclear Imaging & Therapy | 207UN0902X | A93513 | California |
| Allopathic & Osteopathic Physicians / Nuclear Imaging & Therapy | 207UN0902X | N5255 | Texas |
| Allopathic & Osteopathic Physicians / Nuclear Imaging & Therapy | 207UN0902X | MD0000046850 | Tennessee |
Profile Details
| NPI number | 1235146648 |
|---|---|
| LBN Legal business name | Modarresifar, Homayoun |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 1st, 2006 |
| Last updated | May 13th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235146648 | NPPES |
| Tennessee | Other | MD0000046850 | TENNESSEE MEDICAL LICENSE |
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