Provider Demographics
NPI:1720312390
Name:ABAY, DEMSAS G,HAWARIAT (MD)
Entity Type:Individual
Prefix:
First Name:DEMSAS
Middle Name:G,HAWARIAT
Last Name:ABAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEMSAS
Other - Middle Name:GHEBREHAWARIAT
Other - Last Name:ABBAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7700 W ASPERA BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7917
Mailing Address - Country:US
Mailing Address - Phone:936-537-9197
Mailing Address - Fax:281-364-0693
Practice Address - Street 1:13350 N 94TH DR STE A101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4826
Practice Address - Country:US
Practice Address - Phone:623-974-1500
Practice Address - Fax:623-933-3383
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60115986207R00000X
AZ46567207R00000X
TXN4229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050WSOtherBCBS