=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366546665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMAD ZAKY QASIMYAR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2006
-----------------------------------------------------
Last Update Date | 10/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5048 W NORTHERN AVE STE 106
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85301-1558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-435-0190
-----------------------------------------------------
Fax | 623-435-0193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5048 W. NORTHERN AVE SUITE 106
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85301-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-435-0190
-----------------------------------------------------
Fax | 623-435-0193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101236183
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 41474
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------