Provider Demographics
NPI:1902203201
Name:A&B INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:A&B INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-246-0261
Mailing Address - Street 1:1150 W 24TH ST
Mailing Address - Street 2:STE E
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8368
Mailing Address - Country:US
Mailing Address - Phone:928-783-3445
Mailing Address - Fax:520-378-0123
Practice Address - Street 1:1150 W 24TH ST
Practice Address - Street 2:STE E
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8368
Practice Address - Country:US
Practice Address - Phone:928-783-3445
Practice Address - Fax:520-378-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty