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General NPI Number Information
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NPI Number | 1568674661
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Entity Type | Organization
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Legal Business Name | MOJAVE DIABETES AND ENDOCRINOLOGY
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 3003 HWY 95 SUITE 100
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 928-704-5400
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Fax | 928-704-5411
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Provider Business Mailing Address
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Address Line | 3003 HWY 95 SUITE 100
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 928-704-5400
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Fax | 928-704-5411
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Authorized Official
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Title or Position | OWNER
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Name | DR. MUSHTAQ ALI SYED
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Credential | MD
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Telephone | 928-704-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 33330
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License Number State | AZ
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