Provider Demographics
NPI:1023059508
Name:BAZZI, ALEIX M (MD)
Entity type:Individual
Prefix:
First Name:ALEIX
Middle Name:M
Last Name:BAZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEIX
Other - Middle Name:MAXIMUS
Other - Last Name:BAZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2095 W. 24TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-314-1200
Mailing Address - Fax:928-314-1201
Practice Address - Street 1:2095 W. 24TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-314-1200
Practice Address - Fax:928-314-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31294207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0736450OtherBLUE CROSS BLUE SHIELD
AZP00031081OtherRAIL ROAD MEDICARE
AZ795940Medicaid
AZAW6552OtherHEALTH NET
AZ7157517OtherAETNA
AZP00031081OtherRAIL ROAD MEDICARE
AZH10342Medicare UPIN