Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 50783 | AZ |
N | 208600000X | Surgeon | 50783 | AZ |
Y | 2086X0206X | Surgical Oncologist | 50783 | AZ |
NPI | 1023241544 |
---|---|
Provider Name | Dr. Mohammad Rida Khreiss |
First Address | Tucson, AZ 85732-3627 |
Second Address | Tucson, AZ 85712-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 13/07/2015 |