Provider Demographics
NPI:1760778906
Name:IQBAL, MAAZ (MD)
Entity Type:Individual
Prefix:
First Name:MAAZ
Middle Name:
Last Name:IQBAL
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 1:535 E MCKELLIPS RD STE 121
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2527
Mailing Address - Country:US
Mailing Address - Phone:480-900-7373
Mailing Address - Fax:480-900-6844
Practice Address - Street 1:535 E MCKELLIPS RD STE 121
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2527
Practice Address - Country:US
Practice Address - Phone:480-900-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72526207R00000X
AZ52281208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ52281OtherAZ MEDICAL LICENCE
AZR72526OtherTRAINING PERMIT