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General NPI Number Information
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NPI Number | 1427583566
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Entity Type | Individual
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Provider Name | TAIF MUKHDOMI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1200 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-779-3366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 738247
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City | DALLAS
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State | TX
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Zip | 75373-8247
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Country | US
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Telephone | 614-647-2526
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Fax | 877-409-2415
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | LP04360
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 309546-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 75027
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License Number State | AZ
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