Healthcare Provider Details

I. General information

NPI: 1467816603
Provider Name (Legal Business Name): ALI MOHAMMED ASSERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N. CAMPBELL AVE
TUCSON AZ
85724
US

IV. Provider business mailing address

3220 W INA RD APT#17104
TUCSON AZ
85741-2160
US

V. Phone/Fax

Practice location:
  • Phone: 520-328-9448
  • Fax:
Mailing address:
  • Phone: 520-328-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberR75425
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: