Provider Demographics
NPI:1164863569
Name:HUDEEB, MOHAMMAD ALI HASAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ALI HASAN
Last Name:HUDEEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:289 S HIGHWAY 92
Mailing Address - Street 2:APT 9103
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3678
Mailing Address - Country:US
Mailing Address - Phone:301-273-8683
Mailing Address - Fax:
Practice Address - Street 1:5700 E HIGHWAY 90
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-9110
Practice Address - Country:US
Practice Address - Phone:520-263-3180
Practice Address - Fax:520-263-3184
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZR74171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine