Healthcare Provider Details

I. General information

NPI: 1437447745
Provider Name (Legal Business Name): MOHAMMAD FAZEL MD, PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 N LA CHOLLA BLVD
TUCSON AZ
85741-2307
US

IV. Provider business mailing address

7544 N LA CHOLLA BLVD
TUCSON AZ
85741-2307
US

V. Phone/Fax

Practice location:
  • Phone: 520-261-5205
  • Fax: 520-613-2775
Mailing address:
  • Phone: 520-261-5205
  • Fax: 520-613-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number66757
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS019814
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number66757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: