Healthcare Provider Details

I. General information

NPI: 1760778906
Provider Name (Legal Business Name): MAAZ IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E MCKELLIPS RD STE 121
MESA AZ
85203-2527
US

IV. Provider business mailing address

535 E MCKELLIPS RD STE 121
MESA AZ
85203-2527
US

V. Phone/Fax

Practice location:
  • Phone: 480-900-7373
  • Fax:
Mailing address:
  • Phone: 480-900-7373
  • Fax: 480-900-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR72526
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number52281
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number52281
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierR72526
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerTRAINING PERMIT
# 2
Identifier52281
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerAZ MEDICAL LICENCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: