Provider Demographics
NPI:1265410369
Name:BADER, MOHAMMAD Y (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:Y
Last Name:BADER
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 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7214
Mailing Address - Country:US
Mailing Address - Phone:520-626-6627
Mailing Address - Fax:520-626-5009
Practice Address - Street 1:1501 N CAMPBELL AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724
Practice Address - Country:US
Practice Address - Phone:520-626-6627
Practice Address - Fax:520-626-5009
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0209208000000X
AZ440782080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85678554Medicaid