Provider Demographics
NPI:1750054730
Name:AL MAAYAIH, AL MAMOON YOUSEF HAMDAN (MD)
Entity Type:Individual
Prefix:
First Name:AL MAMOON
Middle Name:YOUSEF HAMDAN
Last Name:AL MAAYAIH
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 1:4400 E BUSBY DR APT NO1147
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-3935
Mailing Address - Country:US
Mailing Address - Phone:520-678-5560
Mailing Address - Fax:
Practice Address - Street 1:5700 E, AZ-90, SIERRA VISTA, AZ 85635
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-263-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR78880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty