Provider Demographics
NPI:1518317031
Name:EFIMOV, ALEXANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:EFIMOV
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 1:1300 S COUNTRY CLUB DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5162
Mailing Address - Country:US
Mailing Address - Phone:480-827-5500
Mailing Address - Fax:
Practice Address - Street 1:1300 S COUNTRY CLUB DR STE 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5162
Practice Address - Country:US
Practice Address - Phone:480-827-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10584207Q00000X
AZ63514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine