Healthcare Provider Details

I. General information

NPI: 1225038946
Provider Name (Legal Business Name): GHOLAM A PEYMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13624 W CAMINO DEL SOL STE 200B
SUN CITY WEST AZ
85375-3401
US

IV. Provider business mailing address

13624 W CAMINO DEL SOL STE 200B
SUN CITY WEST AZ
85375-3401
US

V. Phone/Fax

Practice location:
  • Phone: 623-474-3937
  • Fax: 623-289-7901
Mailing address:
  • Phone: 623-474-3937
  • Fax: 623-289-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31729
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number31729
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: