Provider Demographics
NPI:1679788418
Name:MOUKABARY, TALAL (MD)
Entity Type:Individual
Prefix:
First Name:TALAL
Middle Name:
Last Name:MOUKABARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:445 N SILVERBELL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2685
Mailing Address - Country:US
Mailing Address - Phone:520-396-1370
Mailing Address - Fax:520-396-1375
Practice Address - Street 1:3501 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3917
Practice Address - Country:US
Practice Address - Phone:520-833-5171
Practice Address - Fax:520-318-7107
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ42117207RC0000X, 207RC0001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825848Medicaid