Provider Demographics
NPI:1144206277
Name:NEAVE KHOURY, MARTI E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARTI
Middle Name:E
Last Name:NEAVE KHOURY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6008
Mailing Address - Country:US
Mailing Address - Phone:480-969-1446
Mailing Address - Fax:480-969-9105
Practice Address - Street 1:1950 S COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6008
Practice Address - Country:US
Practice Address - Phone:480-969-1446
Practice Address - Fax:480-969-9105
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1396363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ73878Medicare PIN
AZS60154Medicare UPIN