Provider Demographics
NPI:1275728875
Name:INTERNAL MEDICINE SPECIALISTS, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHOUBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-249-0115
Mailing Address - Street 1:6036 N 19TH AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2142
Mailing Address - Country:US
Mailing Address - Phone:602-249-0115
Mailing Address - Fax:602-249-0877
Practice Address - Street 1:6036 N 19TH AVE STE 402
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2142
Practice Address - Country:US
Practice Address - Phone:602-249-0115
Practice Address - Fax:602-249-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCHWQMedicare PIN