Healthcare Provider Details

I. General information

NPI: 1356536544
Provider Name (Legal Business Name): PLASTIC SURGEONS OF NORTHERN ARIZONA,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N SAN FRANCISCO ST SUITE 200
FLAGSTAFF AZ
86001-3281
US

IV. Provider business mailing address

1020 N SAN FRANCISCO ST SUITE 200
FLAGSTAFF AZ
86001-3281
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-2300
  • Fax:
Mailing address:
  • Phone: 928-774-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: STEVEN T SCHWARTZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 928-774-2300