Provider Demographics
NPI:1457311367
Name:OWUSU DOMMEY, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:OWUSU DOMMEY
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:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-2510
Mailing Address - Country:US
Mailing Address - Phone:480-821-9339
Mailing Address - Fax:480-821-9555
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:STE 123
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1503
Practice Address - Country:US
Practice Address - Phone:480-821-9339
Practice Address - Fax:480-821-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ491176Medicaid
AZ491176Medicaid
AZZ111834Medicare PIN
AZ63434Medicare ID - Type UnspecifiedMEDICARE NUMBER
AZZ111835Medicare PIN