Individual
MARTIN MAZEN ANBARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-4056
(417) 269-5556
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3462
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
103662
MO
2085R0204X
Vascular & Interventional Radiology Physician
Primary
103662
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1256
BLUE
MO
05
—
134172001
—
AR
05
—
209799006
—
MO
01
—
300085565
RRR MEDICARE
MO
01
—
A008
TRICARE
MO
Enumeration date
03/27/2006
Last updated
03/22/2018
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