Healthcare Provider Details

I. General information

NPI: 1407240716
Provider Name (Legal Business Name): MOIZ MOHAMMAD DAWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N PECOS RD STE 120
HENDERSON NV
89074-7364
US

IV. Provider business mailing address

3333 E CAMELBACK RD STE 180
PHOENIX AZ
85018-2396
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-7510
  • Fax:
Mailing address:
  • Phone: 602-759-6883
  • Fax: 602-224-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMO2021-0309
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD2021-0309
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number67807
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number19176
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: