Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 45684 | AZ |
Y | 111NI0900X | Internist | 45684 | AZ |
NPI | 1003141417 |
---|---|
Provider Name | Dr. Ali Shaheen Al-Yaqoobi |
First Address | Phoenix, AZ 85016-8034 |
Second Address | Phoenix, AZ 85008-4973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2009 |
Last Update Date | 06/05/2014 |