Basic Information
| Provider Information | |||||||||
| NPI: | 1437447745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAZEL | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7165 N PIMA CANYON DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857181407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206943376 | ||||||||
| FaxNumber: | 5208747102 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N CAMPBELL AVE RM 6336 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857245040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206262761 | ||||||||
| FaxNumber: | 5206266020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2011 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S019814 | AZ | N | Pharmacy Service Providers | Pharmacist | 207R00000X | R76653 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | I009315 | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | R76653 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.