Basic Information
| Provider Information | |||||||||
| NPI: | 1679788418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUKABARY | ||||||||
| FirstName: | TALAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 N SILVERBELL RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203961370 | ||||||||
| FaxNumber: | 5203961375 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 E SPEEDWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857163917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208335171 | ||||||||
| FaxNumber: | 5203187107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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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 | 207RC0000X | 42117 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 42117 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207R00000X | 42117 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 825848 | 05 | AZ | MEDICAID |