Healthcare Provider Details

I. General information

NPI: 1467744490
Provider Name (Legal Business Name): MARTIN PAUL ZOMAYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 N 7TH ST STE 105
PHOENIX AZ
85014-1803
US

IV. Provider business mailing address

2320 N 3RD ST
PHOENIX AZ
85004-1303
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-7430
  • Fax: 602-279-5333
Mailing address:
  • Phone: 602-258-9900
  • Fax: 602-258-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number56031
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: