Healthcare Provider Details

I. General information

NPI: 1497860050
Provider Name (Legal Business Name): ARIZONA ALLERGY AND ARTHRITIS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E OAK AVE SUITE 202
FLAGSTAFF AZ
86001-1818
US

IV. Provider business mailing address

107 E OAK AVE SUITE 202
FLAGSTAFF AZ
86001-1818
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2560
  • Fax: 928-913-8835
Mailing address:
  • Phone: 928-773-2560
  • Fax: 928-913-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number19589
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number19589
License Number StateAZ

VIII. Authorized Official

Name: KENNETH A EPSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 928-773-2560