Provider Demographics
NPI:1912908039
Name:AYUBI-MOAK, INEKE MARYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:INEKE
Middle Name:MARYAM
Last Name:AYUBI-MOAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:INEKE
Other - Middle Name:MARYAM
Other - Last Name:AYUBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-0001
Mailing Address - Country:US
Mailing Address - Phone:602-285-1255
Mailing Address - Fax:602-528-1255
Practice Address - Street 1:483 W. SEED FARM RD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-0038
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:602-528-1255
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ728760OtherBCBS
5467450OtherFIRST HEALTH
7329456OtherAETNA
AZ9435OtherHEALTHNET
80192212OtherRR MEDICARE
8176829002OtherCIGNA 200
AZ728760OtherBCBS
H66802Medicare UPIN