Provider Demographics
NPI:1760671804
Name:BASHIR AHMED AZHER PC
Entity Type:Organization
Organization Name:BASHIR AHMED AZHER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASHIR
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:AZHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-763-5110
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14725208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ239542Medicaid
AZ239542Medicaid
AZ0000BGMBZMedicare PIN