Provider Demographics
NPI:1790943900
Name:MUALA, SAMER MOHD FARUQ (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:MOHD FARUQ
Last Name:MUALA
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 1:14175 W INDIAN SCHOOL RD STE B4-496
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8407
Mailing Address - Country:US
Mailing Address - Phone:831-756-2399
Mailing Address - Fax:
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:831-756-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48268208M00000X
CAA103721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist