Healthcare Provider Details

I. General information

NPI: 1326958190
Provider Name (Legal Business Name): MOUSTAFA BANNA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W THUNDERBIRD BLVD
SUN CITY AZ
85351-3004
US

IV. Provider business mailing address

11124 W CALIFORNIA AVE STE G
YOUNGTOWN AZ
85363-1246
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-2073
  • Fax:
Mailing address:
  • Phone: 623-583-2073
  • Fax: 623-583-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PEGGY JETER
Title or Position: OFFICE MANAGER
Credential:
Phone: 623-583-2073