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General NPI Number Information
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NPI Number | 1164863569
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Entity Type | Individual
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Provider Name | MOHAMMAD ALI HASAN HUDEEB M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2013
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 5700 E HIGHWAY 90 HOSPITALIST OFFICE
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-9110
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Country | US
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Telephone | 520-263-3180
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Fax | 520-263-3184
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Provider Business Mailing Address
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Address Line | 289 S HIGHWAY 92 APT 9103
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-3678
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Country | US
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Telephone | 301-273-8683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R74171
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License Number State | AZ
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