Provider Demographics
NPI:1265472443
Name:RAZZAQ, JAMIL (DO)
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:
Last Name:RAZZAQ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-583-5260
Practice Address - Street 1:14416 W MEEKER BLVD
Practice Address - Street 2:BLDG C
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5284
Practice Address - Country:US
Practice Address - Phone:623-583-5083
Practice Address - Fax:623-583-5260
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ848129Medicaid
AZ848129Medicaid
AZP00151869Medicare PIN
AZZ83598Medicare PIN
AZZ83594Medicare PIN