Provider Demographics
NPI:1073502787
Name:S K MASOOD MD PA
Entity Type:Organization
Organization Name:S K MASOOD MD PA
Other - Org Name:THE SPECIALISTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:K
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-924-2288
Mailing Address - Street 1:215 S POWER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5236
Mailing Address - Country:US
Mailing Address - Phone:480-924-2288
Mailing Address - Fax:
Practice Address - Street 1:215 S POWER RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5236
Practice Address - Country:US
Practice Address - Phone:480-924-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDE3116OtherRAIL ROAD MEDICARE
AZZ106478Medicare PIN