Provider Demographics
NPI:1184676504
Name:MAHOUBI, RAY R (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:R
Last Name:MAHOUBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:602-249-0115
Mailing Address - Fax:602-246-0837
Practice Address - Street 1:6036 N 19TH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2106
Practice Address - Country:US
Practice Address - Phone:602-249-0115
Practice Address - Fax:602-246-7029
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11ZWCHWQ05Medicare PIN
F75919Medicare UPIN
AZZ184838Medicare PIN