Provider Demographics
NPI:1760853360
Name:ABUDRA, AHMED ADAM
Entity Type:Individual
Prefix:
First Name:AHMED ADAM
Middle Name:
Last Name:ABUDRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ADAM
Other - Middle Name:M
Other - Last Name:ABUDRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:MANAGED CARE DEPARTMENT
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:602-933-1820
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-1900
Practice Address - Fax:602-933-1918
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant