Provider Demographics
NPI:1770572976
Name:ZARA, MOHAMMED T (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:T
Last Name:ZARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1637 E MONUMENT PLAZA CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5639
Mailing Address - Country:US
Mailing Address - Phone:520-426-1512
Mailing Address - Fax:520-426-7150
Practice Address - Street 1:1637 E MONUMENT PLAZA CIR STE 1
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5639
Practice Address - Country:US
Practice Address - Phone:520-426-1512
Practice Address - Fax:520-426-7150
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ22548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF89178Medicare UPIN
AZZ29958Medicare PIN