Provider Demographics
NPI:1881441681
Name:GOBRAN SHAHLA MD PLLC
Entity type:Organization
Organization Name:GOBRAN SHAHLA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOBRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-900-5181
Mailing Address - Street 1:25255 N 44TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1690
Mailing Address - Country:US
Mailing Address - Phone:480-341-0003
Mailing Address - Fax:
Practice Address - Street 1:9139 W THUNDERBIRD RD STE 275
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4922
Practice Address - Country:US
Practice Address - Phone:623-900-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty