Provider Demographics
NPI:1417245267
Name:BUCAJ, MERIMA (DO)
Entity Type:Individual
Prefix:DR
First Name:MERIMA
Middle Name:
Last Name:BUCAJ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W BETHANY HOME RD # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2443
Mailing Address - Country:US
Mailing Address - Phone:602-246-5525
Mailing Address - Fax:602-433-6686
Practice Address - Street 1:2000 W BETHANY HOME RD # 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-246-5525
Practice Address - Fax:602-433-6686
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE967207Q00000X
390200000X
AZ007534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007534OtherFAMILY MEDICINE