| NPI | 1144629916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON R MOORE Executive Director 480-889-1580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |