Healthcare Provider Details

I. General information

NPI: 1902095094
Provider Name (Legal Business Name): ALI MOHAMAD ESKANDAR MBBCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 11/27/2023
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E FLORENCE BLVD
CASA GRANDE AZ
85122-5303
US

IV. Provider business mailing address

PO BOX 20610
MESA AZ
85277-0610
US

V. Phone/Fax

Practice location:
  • Phone: 520-426-6300
  • Fax:
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-985-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number43846
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number43846
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: