Provider Demographics
NPI:1689605404
Name:AZHER, BASHIR A (MD)
Entity Type:Individual
Prefix:
First Name:BASHIR
Middle Name:A
Last Name:AZHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1467 PALMA RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6785
Mailing Address - Country:US
Mailing Address - Phone:928-763-5110
Mailing Address - Fax:928-763-1091
Practice Address - Street 1:1467 PALMA RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6785
Practice Address - Country:US
Practice Address - Phone:928-763-5110
Practice Address - Fax:928-763-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ14725208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0181640OtherBLUE CROSS
AZ239542002Medicaid
AZC99080Medicare UPIN
AZAZ0181640OtherBLUE CROSS