Healthcare Provider Details

I. General information

NPI: 1306435086
Provider Name (Legal Business Name): PHOENIX SPINE AND JOINT GILBERT ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 128
GILBERT AZ
85295-3206
US

IV. Provider business mailing address

2525 E ARIZONA BILTMORE CIR STE D142
PHOENIX AZ
85016-2147
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-2525
  • Fax: 602-256-0795
Mailing address:
  • Phone: 602-256-2525
  • Fax: 602-256-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL LIEBERMAN
Title or Position: CEO
Credential: MD
Phone: 602-256-2525