Healthcare Provider Details

I. General information

NPI: 1154554236
Provider Name (Legal Business Name): RAWAD MOUNZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 12TH ST
PHOENIX AZ
85006-2837
US

IV. Provider business mailing address

1441N 12TH ST. DIGESTIVE INSTITUTE
PHOENIX AZ
85006
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-5180
  • Fax: 602-521-5180
Mailing address:
  • Phone: 602-521-5180
  • Fax: 602-521-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD443952
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: