Healthcare Provider Details

I. General information

NPI: 1093750754
Provider Name (Legal Business Name): WEDAD MOHAMMED KHEDR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E MAIN ST BLDG B
SOMERTON AZ
85350-7409
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-236-8001
  • Fax: 928-722-6113
Mailing address:
  • Phone: 928-315-7910
  • Fax: 928-722-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036091500
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66835
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: