Provider Demographics
NPI:1013036516
Name:AL-KHOUDARI, AMER (MD)
Entity Type:Individual
Prefix:
First Name:AMER
Middle Name:
Last Name:AL-KHOUDARI
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 1:604 W WARNER RD STE C1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2915
Mailing Address - Country:US
Mailing Address - Phone:480-372-8200
Mailing Address - Fax:480-372-8222
Practice Address - Street 1:604 W WARNER RD STE C1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2915
Practice Address - Country:US
Practice Address - Phone:480-372-8200
Practice Address - Fax:480-372-8222
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49983207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK69024Medicaid