Healthcare Provider Details

I. General information

NPI: 1497960926
Provider Name (Legal Business Name): ELIZABETH CHANGE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N GILBERT RD SUITE L
GILBERT AZ
85234-2328
US

IV. Provider business mailing address

1400 N GILBERT RD SUITE L
GILBERT AZ
85234-2328
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-7946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA JULIAN
Title or Position: BILLING MANAGER
Credential:
Phone: 480-776-2825