MEDICARE: REGINALD C. OPARA M.D.

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	207L00000X	Anesthesiology Physician	29287	AZ

General Provider Information

NPI Number	:	1528064151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD C. OPARA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 39179
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85069-9179
Country	:	US
Telephone Number	:	602-395-0718
Fax Number	:	602-277-8146

Provider Business Practice Location Address
First Line	:	1715 W NORTHERN AVE
Second Line	:	#108
City	:	PHOENIX
State	:	AZ
Zip	:	85021
Country	:	US
Telephone Number	:	602-395-0718
Fax Number	:	602-277-8146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	02/21/2008

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