Provider Demographics
NPI:1770879835
Name:MOZAFFARI, BASIM (DO)
Entity type:Individual
Prefix:DR
First Name:BASIM
Middle Name:
Last Name:MOZAFFARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BASIM
Other - Middle Name:
Other - Last Name:MOZAFFARI-NEJAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:9590 E IRONWOOD SQUARE DR
Mailing Address - Street 2:STE 125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4583
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:866-819-6115
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR
Practice Address - Street 2:STE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4583
Practice Address - Country:US
Practice Address - Phone:480-455-3000
Practice Address - Fax:866-819-6115
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011109208M00000X
AZ006799208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ65772Medicaid
AZZ181715Medicare PIN