Healthcare Provider Details

I. General information

NPI: 1760622344
Provider Name (Legal Business Name): ABDUL MEMON, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5882 S HOSPITAL DR STE 1
GLOBE AZ
85501-9455
US

IV. Provider business mailing address

5882 S HOSPITAL DR STE 1
GLOBE AZ
85501-9455
US

V. Phone/Fax

Practice location:
  • Phone: 928-793-3747
  • Fax: 928-793-3745
Mailing address:
  • Phone: 928-793-3747
  • Fax: 928-793-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24282
License Number StateAZ

VIII. Authorized Official

Name: DR. ABDUL Q MEMON
Title or Position: OWNER
Credential: MD
Phone: 928-793-3747