Provider Demographics
NPI:1033181151
Name:SATTARI, MEHDI (MD)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:SATTARI
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:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Mailing Address - Street 2:1901 RED ROCK DRIVE
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:505-726-6875
Mailing Address - Fax:
Practice Address - Street 1:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Practice Address - Street 2:1901 RED ROCK DRIVE
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-7000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2003-0685207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37621211Medicaid
AZ854845Medicaid
NMNM007580OtherBCBS
85031326887301A174OtherCHAMPUS
NM10014950OtherLOVELACE HEALTH/SALUD
NMQMYPR0067239OtherMOLINA
AZ854845Medicaid