Provider Demographics
NPI:1336106152
Name:SHAHLAPOUR, MAHMOOD R (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:R
Last Name:SHAHLAPOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 N HIGLEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5398
Mailing Address - Country:US
Mailing Address - Phone:888-825-8575
Mailing Address - Fax:888-406-4076
Practice Address - Street 1:1042 N HIGLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-5398
Practice Address - Country:US
Practice Address - Phone:888-825-8575
Practice Address - Fax:888-406-4076
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH57445Medicare UPIN
AZP00354166Medicare PIN
AZZ112343Medicare PIN