Provider Demographics
NPI:1396851044
Name:RAZA, SAMEERA (MD)
Entity Type:Individual
Prefix:
First Name:SAMEERA
Middle Name:
Last Name:RAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2494
Mailing Address - Country:US
Mailing Address - Phone:602-336-1966
Mailing Address - Fax:602-336-0044
Practice Address - Street 1:5830 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2494
Practice Address - Country:US
Practice Address - Phone:602-336-1966
Practice Address - Fax:602-336-0044
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I66513Medicare UPIN