Individual
EDWIN MGBAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
483 W. SEED FARM RD., SACATON, AZ 85147-0038
(602) 528-1200
(602) 528-1255
Mailing address
483 W. SEED FARM RD., SACATON, AZ 85147-0038
(602) 528-1200
(602) 528-1255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33253
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88130101
—
AZ
Enumeration date
03/23/2006
Last updated
03/02/2012
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