Provider Demographics
NPI:1407297823
Name:WAZIR, SHOAIB MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:SHOAIB
Middle Name:MUHAMMAD
Last Name:WAZIR
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 1:3333 E CAMELBACK RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2396
Mailing Address - Country:US
Mailing Address - Phone:602-997-0484
Mailing Address - Fax:602-943-1453
Practice Address - Street 1:3320 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2319
Practice Address - Country:US
Practice Address - Phone:602-200-8288
Practice Address - Fax:602-200-8627
Is Sole Proprietor?:No
Enumeration Date:2013-07-14
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458322207R00000X
AZ64012207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ262200Medicaid