Provider Demographics
NPI:1679143283
Name:AHMED, BAKAR HASSAN
Entity type:Individual
Prefix:MR
First Name:BAKAR
Middle Name:HASSAN
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 E REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7858
Mailing Address - Country:US
Mailing Address - Phone:480-999-3829
Mailing Address - Fax:
Practice Address - Street 1:4718 E REDFIELD RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-7858
Practice Address - Country:US
Practice Address - Phone:480-999-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH6846251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health