Provider Demographics
NPI:1003869629
Name:MUNAYIRJI, AZIZ GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:AZIZ
Middle Name:GEORGE
Last Name:MUNAYIRJI
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 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:999 N CURTIS RD
Practice Address - Street 2:SUITE 415
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1334
Practice Address - Country:US
Practice Address - Phone:208-367-7676
Practice Address - Fax:208-367-5595
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8137208600000X
IDM-8137208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805941500Medicaid
ID1145348Medicare PIN
F35457Medicare UPIN