Healthcare Provider Details

I. General information

NPI: 1942693098
Provider Name (Legal Business Name): BASHA IMTIYAZ MOHAMMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ABDUL MAHMAD MD

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PHELPS DR
APACHE JUNCTION AZ
85120-6700
US

IV. Provider business mailing address

PO BOX 24981
BELFAST ME
04915-2000
US

V. Phone/Fax

Practice location:
  • Phone: 480-536-6850
  • Fax: 602-834-1592
Mailing address:
  • Phone: 480-536-6850
  • Fax: 602-834-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50273
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50273
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: