Provider Demographics
NPI:1609395847
Name:GHAFOOR, BAHOO (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHOO
Middle Name:
Last Name:GHAFOOR
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 1:6218 S RITA LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3023
Mailing Address - Country:US
Mailing Address - Phone:480-839-4577
Mailing Address - Fax:
Practice Address - Street 1:1030 E GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3044
Practice Address - Country:US
Practice Address - Phone:480-491-1898
Practice Address - Fax:480-629-5246
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
AZ604952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ122246Medicaid