Provider Demographics
NPI:1386895126
Name:MOHAVE GASTROENTEROLOGY, PC
Entity type:Organization
Organization Name:MOHAVE GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIIZAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-763-2500
Mailing Address - Street 1:2020 SILVER CREEK RD
Mailing Address - Street 2:BUILDING A SUITE 220
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8476
Mailing Address - Country:US
Mailing Address - Phone:928-763-2500
Mailing Address - Fax:928-763-0027
Practice Address - Street 1:2020 SILVER CREEK RD
Practice Address - Street 2:BUILDING A SUITE 220
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8476
Practice Address - Country:US
Practice Address - Phone:928-763-2500
Practice Address - Fax:928-763-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty