Basic Information
| Provider Information | |||||||||
| NPI: | 1720281801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAKDESI | ||||||||
| FirstName: | MASON | ||||||||
| MiddleName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10401 W THUNDERBIRD BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238765622 | ||||||||
| FaxNumber: | 6238152931 | ||||||||
| Practice Location | |||||||||
| Address1: | 10401 W THUNDERBIRD BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853513004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238765622 | ||||||||
| FaxNumber: | 6238152931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37397 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.