| NPI | 1376360644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREDENTIALING MANAGER Credentialing Director 602-385-2115 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery Hand Surgery |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery | |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine | |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| 208VP0000X Pain Medicine Pain Medicine | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 213E00000X Podiatrist | |
| 213ES0103X Podiatrist Foot & Ankle Surgery | |
| 261QR0200X Clinic/Center Radiology | |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2025-02-24 |