Healthcare Provider Details

I. General information

NPI: 1134553100
Provider Name (Legal Business Name): MOHAMED AZIZ MAHMOUD SHAABAN M.D., MSC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7170
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7170
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-2000
  • Fax: 928-336-7430
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number59818
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: