Individual
HOMAYOUN MODARRESIFAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2109 W MARKET ST STE 122, ETSU, INNOVATION LABORATORY, JOHNSON CITY, TN 37604-6024
(423) 439-8000
Mailing address
2109 W MARKET ST STE 122, ETSU, INNOVATION LABORATORY, JOHNSON CITY, TN 37604-6024
(423) 439-8000
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
41198
AZ
207UN0902X
Nuclear Imaging & Therapy Physician
A93513
CA
207UN0902X
Nuclear Imaging & Therapy Physician
Primary
MD0000046850
TN
207UN0902X
Nuclear Imaging & Therapy Physician
N5255
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD0000046850
TENNESSEE MEDICAL LICENSE
TN
Enumeration date
08/01/2006
Last updated
05/13/2011
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