Basic Information
Provider Information | |||||||||
NPI: | 1679857825 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GOOD HEALTH MEDICAL, P.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MY DR NOW | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 261 N ROOSEVELT AVE | ||||||||
Address2: |   | ||||||||
City: | CHANDLER | ||||||||
State: | AZ | ||||||||
PostalCode: | 852262616 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4803052888 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 428 S. GILBERT RD. | ||||||||
Address2: | SUITE # 101 | ||||||||
City: | GILBERT | ||||||||
State: | AZ | ||||||||
PostalCode: | 852962261 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4806778282 | ||||||||
FaxNumber: | 4805350962 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2011 | ||||||||
LastUpdateDate: | 08/27/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZAMANI | ||||||||
AuthorizedOfficialFirstName: | PAYAM | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 4803052888 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34305 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 367745 | 05 | AZ |   | MEDICAID | 1679857825 | 01 | AZ | MEDICARE NPI | OTHER |