Provider Demographics
NPI:1447246129
Name:AZIMA, PAYAM (MD)
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:AZIMA
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 1:8328 E. HARTFORD DR.
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-882-4335
Mailing Address - Fax:480-882-5705
Practice Address - Street 1:8328 E. HARTFORD DR.
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-214-9720
Practice Address - Fax:480-214-9722
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30735207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ752180Medicaid
AZ80858Medicare ID - Type Unspecified
2144239Medicare PIN
AZZ122127Medicare PIN
AZ752180Medicaid