Provider Demographics
NPI:1801832977
Name:MOSHARRAFA, TAMIR (MD)
Entity Type:Individual
Prefix:
First Name:TAMIR
Middle Name:
Last Name:MOSHARRAFA
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 1:4611 E SHEA BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4259
Mailing Address - Country:US
Mailing Address - Phone:602-513-8133
Mailing Address - Fax:602-230-1465
Practice Address - Street 1:4611 E SHEA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:602-513-8133
Practice Address - Fax:602-230-1465
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ326052086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0752270OtherBCBS
AZ7630208OtherAETNA
AZ844127Medicaid
AZ7630208OtherAETNA
H26363Medicare UPIN