Healthcare Provider Details

I. General information

NPI: 1588878508
Provider Name (Legal Business Name): DHEERAJ KUMAR BOBBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 E BROADWAY RD STE 9
MESA AZ
85208-1156
US

IV. Provider business mailing address

7525 E BROADWAY RD STE 9
MESA AZ
85208-1156
US

V. Phone/Fax

Practice location:
  • Phone: 480-981-2700
  • Fax: 480-981-8399
Mailing address:
  • Phone: 480-981-2700
  • Fax: 480-981-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number37192
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37192
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37192
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: