Healthcare Provider Details

I. General information

NPI: 1871075465
Provider Name (Legal Business Name): REMINGTON LEE STEELE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S WATSON RD # A104
BUCKEYE AZ
85326-6303
US

IV. Provider business mailing address

3815 E BELL RD STE 2200
PHOENIX AZ
85032-2139
US

V. Phone/Fax

Practice location:
  • Phone: 623-251-3201
  • Fax: 623-251-3205
Mailing address:
  • Phone: 602-633-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7192
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: