MEDICARE: ARIZONA PHYSICIANS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	28289	AZ
2	208000000X	Pediatrics Physician	28289	AZ
3	207R00000X	Internal Medicine Physician	28289	AZ

General Provider Information

NPI Number	:	1053586917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	5116 W FAWN DR
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-2897
Country	:	US
Telephone Number	:	602-386-2602
Fax Number	:	602-386-2602

Provider Business Practice Location Address
First Line	:	5116 W FAWN DR
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-2897
Country	:	US
Telephone Number	:	602-386-2602
Fax Number	:	602-386-2602

Authorized Official
Title or Position	:	MEMBER
Name	:	LU YAO
Credential	:	MD
Telephone Number	:	602-386-2602

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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Directions to “ARIZONA PHYSICIANS PLLC ” Practice Location

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