Healthcare Provider Details

I. General information

NPI: 1073702148
Provider Name (Legal Business Name): MVP ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 W BELL RD SUITE 102
GLENDALE AZ
85308-3589
US

IV. Provider business mailing address

4344 W BELL RD SUITE 102
GLENDALE AZ
85308-3589
US

V. Phone/Fax

Practice location:
  • Phone: 602-588-4040
  • Fax: 602-588-4034
Mailing address:
  • Phone: 602-588-4040
  • Fax: 602-588-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2684
License Number StateAZ

VIII. Authorized Official

Name: DELBERT MATTHEW MADDOX
Title or Position: OWNER/PRESIDENT
Credential: D.O.
Phone: 602-588-4040