Healthcare Provider Details

I. General information

NPI: 1043214877
Provider Name (Legal Business Name): ANDREW JOHN PHAM CARROLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N DOBSON RD SUITE 15
CHANDLER AZ
85224
US

IV. Provider business mailing address

333 N DOBSON RD SUITE 15
CHANDLER AZ
85224-4412
US

V. Phone/Fax

Practice location:
  • Phone: 480-282-8336
  • Fax: 480-282-8365
Mailing address:
  • Phone: 480-282-8336
  • Fax: 480-282-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27603
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: