Healthcare Provider Details

I. General information

NPI: 1285167965
Provider Name (Legal Business Name): ABDULLAH JAWAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 N PIMA RD STE 280
SCOTTSDALE AZ
85258-4488
US

IV. Provider business mailing address

2080 W SOLSTICE AVE
APACHE JUNCTION AZ
85120-1237
US

V. Phone/Fax

Practice location:
  • Phone: 480-587-6520
  • Fax:
Mailing address:
  • Phone: 813-451-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number63883
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number167822
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR0075198
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14189873-1205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21884
License Number StateND
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2024-1291
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number77041
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: