Provider Demographics
NPI:1437322898
Name:JAZAERI, OMID (MD)
Entity type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:JAZAERI
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 1:7780 S BROADWAY STE 260
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2633
Mailing Address - Country:US
Mailing Address - Phone:720-330-1300
Mailing Address - Fax:720-452-0757
Practice Address - Street 1:7780 S BROADWAY STE 260
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2633
Practice Address - Country:US
Practice Address - Phone:720-330-1300
Practice Address - Fax:720-452-0757
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO488252086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16689348Medicaid
COCOA101606Medicare PIN