Provider Demographics
NPI:1770743965
Name:NORTHERN ARIZONA MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:NORTHERN ARIZONA MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAFFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-550-0062
Mailing Address - Street 1:3879 N PAINTED TRL
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-1244
Mailing Address - Country:US
Mailing Address - Phone:928-550-0062
Mailing Address - Fax:928-753-4655
Practice Address - Street 1:3879 N PAINTED TRL
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-1244
Practice Address - Country:US
Practice Address - Phone:928-550-0062
Practice Address - Fax:928-753-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty