Provider Demographics
NPI:1902853005
Name:MOODABAGIL, VEERESH (MD)
Entity Type:Individual
Prefix:
First Name:VEERESH
Middle Name:
Last Name:MOODABAGIL
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 1:1656 E NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-9418
Mailing Address - Country:US
Mailing Address - Phone:520-251-1293
Mailing Address - Fax:520-836-4429
Practice Address - Street 1:1800 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5303
Practice Address - Country:US
Practice Address - Phone:520-316-9486
Practice Address - Fax:520-836-4429
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103556Medicare PIN
AZG42891Medicare UPIN