Provider Demographics
NPI:1609832674
Name:MIRZA, IRFAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:IRFAN
Middle Name:M
Last Name:MIRZA
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 1:5653 S HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6068
Mailing Address - Country:US
Mailing Address - Phone:928-768-2558
Mailing Address - Fax:928-768-2874
Practice Address - Street 1:330 S LOLA LN STE 200
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-0879
Practice Address - Country:US
Practice Address - Phone:928-768-2558
Practice Address - Fax:928-788-2039
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28306174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ519332Medicaid
NVV37055Medicare PIN
AZZ72101Medicare PIN
AZ519332Medicaid