Provider Demographics
NPI:1457324204
Name:HAJAIG, NASSER (MD)
Entity type:Individual
Prefix:
First Name:NASSER
Middle Name:
Last Name:HAJAIG
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 1:19646 N 27TH AVE
Mailing Address - Street 2:SUITE 1301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4017
Mailing Address - Country:US
Mailing Address - Phone:623-580-5390
Mailing Address - Fax:623-580-5397
Practice Address - Street 1:19646 N 27TH AVE
Practice Address - Street 2:SUITE 1301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4017
Practice Address - Country:US
Practice Address - Phone:623-580-5390
Practice Address - Fax:623-580-5397
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21043OtherMEDICAID PIN NUMBER
AZ387044Medicaid
AZ387044Medicaid