MEDICARE: DR. HAMDY A MOHTASEB MD, FACP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	35245	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	6441700001	OTHER	AZ	MEDICARE DMERC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12007	OTHER	NV	MD LICENSE
2	40903	OTHER	NJ	AMERIGROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	35245	OTHER	AZ	MD LICENSE

General Provider Information

NPI Number	:	1164423257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMDY A MOHTASEB MD, FACP

Provider Business Mailing Address
First Line	:	1225 HANCOCK RD STE 204
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5962
Country	:	US
Telephone Number	:	928-219-4560
Fax Number	:	928-219-4561

Provider Business Practice Location Address
First Line	:	1225 HANCOCK RD STE 204
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5962
Country	:	US
Telephone Number	:	928-219-4560
Fax Number	:	928-219-4561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	12/17/2020

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