| NPI | 1598392722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRIE TODD Sr. Credentialing Coordinator 480-245-6008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2020-10-26 |