Individual
DR. HAMDY A MOHTASEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACP
Contact information
Practice address
1225 HANCOCK RD STE 204, BULLHEAD CITY, AZ 86442-5962
(928) 219-4560
(928) 219-4561
Mailing address
1225 HANCOCK RD STE 204, BULLHEAD CITY, AZ 86442-5962
(928) 219-4560
(928) 219-4561
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
35245
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12007
MD LICENSE
NV
01
—
35245
MD LICENSE
AZ
01
—
40903
AMERIGROUP
NJ
01
—
6441700001
MEDICARE DMERC
AZ
05
—
6670901
—
NJ
Enumeration date
08/10/2005
Last updated
12/17/2020
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