MEDICARE: DR. NANA N DWOMOH DO

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	207P00000X	Emergency Medicine Physician	4290	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3981220	OTHER	AZ	EVERCARE GRP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AZ0728670	OTHER	AZ	BLUE CROSS BLUE SHIELD GR
4	453051001	OTHER	AZ	GROUP HEALTH GRP
5	AW1436	OTHER	AZ	HEALTHNET GRP
6	860373636	OTHER	AZ	HUMANA GROUP

General Provider Information

NPI Number	:	1568428431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANA N DWOMOH DO

Provider Business Mailing Address
First Line	:	PO BOX 40850
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85274
Country	:	US
Telephone Number	:	480-839-3313
Fax Number	:	480-839-4182

Provider Business Practice Location Address
First Line	:	1201 S 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007
Country	:	US
Telephone Number	:	602-258-5111
Fax Number	:

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	04/09/2019

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Directions to “ DR. NANA N DWOMOH DO” Practice Location

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