Healthcare Provider Details

I. General information

NPI: 1053476853
Provider Name (Legal Business Name): JOEL S SELLERS DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 N 51ST AVE STE F110
GLENDALE AZ
85304-2827
US

IV. Provider business mailing address

11851 N 51ST AVE STE F110
GLENDALE AZ
85304-2827
US

V. Phone/Fax

Practice location:
  • Phone: 602-588-4040
  • Fax:
Mailing address:
  • Phone: 602-252-0859
  • Fax: 602-247-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number2213
License Number StateAZ

VIII. Authorized Official

Name: TIMOTHY MURPHY
Title or Position: VP OPERATIONS
Credential:
Phone: 818-880-8605