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General NPI Number Information
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NPI Number | 1386895126
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Entity Type | Organization
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Legal Business Name | MOHAVE GASTROENTEROLOGY, PC
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 2020 SILVER CREEK RD BUILDING A SUITE 220
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8476
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Country | US
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Telephone | 928-763-2500
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Fax | 928-763-0027
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Provider Business Mailing Address
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Address Line | 2020 SILVER CREEK RD BUILDING A SUITE 220
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8476
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Country | US
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Telephone | 928-763-2500
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Fax | 928-763-0027
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JEFFREY NIIZAWA
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Credential | M.D.
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Telephone | 928-763-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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