MEDICARE: DR. GEORGETTA BIDWELL 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	207RN0300X	Nephrology Physician	7104	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588667109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGETTA BIDWELL M.D.

Provider Business Mailing Address
First Line	:	3333 E CAMELBACK RD
Second Line	:	SUITE 180
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2322
Country	:	US
Telephone Number	:	602-997-0484
Fax Number	:	602-224-3358

Provider Business Practice Location Address
First Line	:	4901 W. MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-0000
Country	:	US
Telephone Number	:	623-849-9088
Fax Number	:	623-849-7875

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/19/2016

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