MEDICARE: BASHIR AHMED AZHER PC

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	208800000X	Urology Physician	14725	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760671804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASHIR AHMED AZHER PC

Provider Business Mailing Address
First Line	:	1467 PALMA RD
Second Line	:	SUITE 4
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6785
Country	:	US
Telephone Number	:	928-763-5110
Fax Number	:	928-763-1091

Provider Business Practice Location Address
First Line	:	1467 PALMA RD
Second Line	:	SUITE 4
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6785
Country	:	US
Telephone Number	:	928-763-5110
Fax Number	:	928-763-1091

Authorized Official
Title or Position	:	OWNER
Name	:	BASHIR AHMED AZHER
Credential	:	MD
Telephone Number	:	928-763-5110

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	03/15/2011

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