Healthcare Provider Details

I. General information

NPI: 1194127464
Provider Name (Legal Business Name): OBADA SUBEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3877 N 7TH ST STE 200
PHOENIX AZ
85014-5084
US

IV. Provider business mailing address

3877 N 7TH ST STE 200
PHOENIX AZ
85014-5084
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-7716
  • Fax: 623-806-8650
Mailing address:
  • Phone: 623-777-7716
  • Fax: 623-806-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number64129
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number64129
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number64129
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: