Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 40875 | AZ |
NPI | 1033307574 |
---|---|
Provider Name | Esmat Mufeed Mustafa |
First Address | Glendale, AZ 85305-2569 |
Second Address | Phoenix, AZ 85032-3359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 27/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
353959 | (05) | AZ |