Provider Demographics
NPI:1750469631
Name:MANSURY, AMAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAN
Middle Name:PAUL
Last Name:MANSURY
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 1:610 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2393
Mailing Address - Country:US
Mailing Address - Phone:623-856-7517
Mailing Address - Fax:
Practice Address - Street 1:2174 W OAK AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-6003
Practice Address - Country:US
Practice Address - Phone:520-364-7931
Practice Address - Fax:520-364-2551
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ184614Medicaid
AZE35167Medicare UPIN