Basic Information
| Provider Information | |||||||||
| NPI: | 1992746408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHEBLEH | ||||||||
| FirstName: | FARID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10645 N TATUM BLVD STE 200623 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850283068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029090909 | ||||||||
| FaxNumber: | 6023714960 | ||||||||
| Practice Location | |||||||||
| Address1: | 8201 N 54TH ST | ||||||||
| Address2: | |||||||||
| City: | PARADISE VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852532522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029090909 | ||||||||
| FaxNumber: | 6235350707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 15863 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 15863 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 15863 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 870261 | 05 | AZ | MEDICAID | 273285 | 05 | AZ | MEDICAID |