Provider Demographics
NPI:1952331043
Name:MOMJIAN, PIERRE N (DPM)
Entity Type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:N
Last Name:MOMJIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 PANICUM DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3831
Mailing Address - Country:US
Mailing Address - Phone:928-710-4338
Mailing Address - Fax:928-776-8623
Practice Address - Street 1:1041 PANICUM DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3831
Practice Address - Country:US
Practice Address - Phone:928-710-4338
Practice Address - Fax:928-776-8623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0512213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ849606Medicaid
AZZ70467Medicare ID - Type Unspecified
AZ849606Medicaid