=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477814739
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHMOOD EL-GASIM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2012
-----------------------------------------------------
Last Update Date | 05/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 N 22ND ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-955-1000
-----------------------------------------------------
Fax | 602-508-4830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 N 22ND ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-955-1000
-----------------------------------------------------
Fax | 602-508-4830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 53975
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | 53975
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207WX0108X
-----------------------------------------------------
Taxonomy Name | Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
-----------------------------------------------------
License Number | 53975
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------