Provider Demographics
NPI:1356460588
Name:MATHUR, AJAY K (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:K
Last Name:MATHUR
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 1:1909 E RAY RD STE 9-154
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8735
Mailing Address - Country:US
Mailing Address - Phone:480-888-5421
Mailing Address - Fax:855-847-8908
Practice Address - Street 1:1909 E RAY RD STE 9-154
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8735
Practice Address - Country:US
Practice Address - Phone:480-888-5421
Practice Address - Fax:855-847-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ36299207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZFM0171619OtherDEA CERTIFICATE