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General NPI Number Information
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NPI Number | 1205804283
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Entity Type | Individual
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Provider Name | MAZEN KHATTAB MD
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 2925 W ROSE GARDEN LN STE 110
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City | PHOENIX
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State | AZ
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Zip | 85027-3135
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Country | US
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Telephone | 623-265-7215
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Fax | 833-465-1462
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Provider Business Mailing Address
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Address Line | 10839 E GOLD DUST AVE
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-4842
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Country | US
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Telephone |
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 42859
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 42859
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License Number State | AZ
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