Healthcare Provider Details

I. General information

NPI: 1902167265
Provider Name (Legal Business Name): SHOIB SARWAR M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

IV. Provider business mailing address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

V. Phone/Fax

Practice location:
  • Phone: 623-207-3000
  • Fax: 623-207-3003
Mailing address:
  • Phone: 623-207-3000
  • Fax: 623-207-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number47580
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number47580
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number47580
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: