Provider Demographics
NPI:1346383387
Name:ARIZONA SURGEON ASSISTANCE
Entity type:Organization
Organization Name:ARIZONA SURGEON ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-616-9982
Mailing Address - Street 1:2000 E SOUTHERN AVE
Mailing Address - Street 2:#105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7510
Mailing Address - Country:US
Mailing Address - Phone:480-820-0627
Mailing Address - Fax:480-820-4840
Practice Address - Street 1:2000 E SOUTHERN AVE
Practice Address - Street 2:#105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7510
Practice Address - Country:US
Practice Address - Phone:480-820-0627
Practice Address - Fax:480-820-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1922363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty