Healthcare Provider Details

I. General information

NPI: 1184329997
Provider Name (Legal Business Name): EDY JOSEPH HATEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

PO BOX 741740
LOS ANGELES CA
90074-1740
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-3000
  • Fax:
Mailing address:
  • Phone: 714-306-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number79639
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79639
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: