Healthcare Provider Details

I. General information

NPI: 1679963839
Provider Name (Legal Business Name): ANWAR M VARDAG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANWAR M VARDAG M.D.

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BEAVER ST
FLAGSTAFF AZ
86001-3118
US

IV. Provider business mailing address

6156 NW 31ST AVE
BOCA RATON FL
33496-3374
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2112
  • Fax:
Mailing address:
  • Phone: 561-488-8368
  • Fax: 561-241-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2026-01221
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number77460
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2026-01221
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0061792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: