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NPI Code Detail

MEDICARE: DR. MEHRDAD SHAFA MD

MEDICARE: DR. MEHRDAD SHAFA MD
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
1207PP0204XPediatric Emergency Medicine (Emergency Medicine) Physician29768AZ

General Provider Information

NPI Number : 1750387171
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MEHRDAD SHAFA MD
Provider Business Mailing Address
First Line : 1919 E THOMAS RD
Second Line : DEPARTMENT OF EMERGENCY MEDICINE
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-546-1900
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line : DEPARTMENT OF EMERGENCY MEDICINE
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-546-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/08/2007

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