Provider Demographics
NPI:1396040697
Name:AHMED, MOHAMED GAAFAR
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:GAAFAR
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 S. PRIEST DR.
Mailing Address - Street 2:# 20
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:602-435-5506
Mailing Address - Fax:
Practice Address - Street 1:3425 S. PRIEST DR.
Practice Address - Street 2:# 20
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:602-435-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD03824309172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28OtherNON-EMERGENCY MEDICAL TRANSPORTATION