Provider Demographics
NPI:1689014094
Name:GHAZALA, LAITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAITH
Middle Name:
Last Name:GHAZALA
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 1:4601 N VIA ENTRADA APT 2087
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5874
Mailing Address - Country:US
Mailing Address - Phone:619-504-0125
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE RM 6408
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5040
Practice Address - Country:US
Practice Address - Phone:520-626-2761
Practice Address - Fax:520-626-6020
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR74031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine