Individual
DR. MOHAMMED MORTAZAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5199 E FARNESS DR STE 101, TUCSON, AZ 85712
(520) 222-8076
(520) 300-7156
Mailing address
5199 E FARNESS DR STE 101, TUCSON, AZ 85712-2262
(520) 222-8076
(520) 300-7156
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
Primary
49421
AZ
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
49421
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871740241
NPI
AZ
05
—
923231
—
AZ
Enumeration date
08/27/2008
Last updated
05/22/2020
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