Healthcare Provider Details

I. General information

NPI: 1932147477
Provider Name (Legal Business Name): KHALED ALBASHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 S MERCY RD
GILBERT AZ
85297-0427
US

IV. Provider business mailing address

3505 S MERCY RD
GILBERT AZ
85297-0427
US

V. Phone/Fax

Practice location:
  • Phone: 480-786-9100
  • Fax:
Mailing address:
  • Phone: 480-612-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29384
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: