Healthcare Provider Details

I. General information

NPI: 1992238968
Provider Name (Legal Business Name): LINDSAY C. BOVEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD STE A100
GLENDALE AZ
85306-4661
US

IV. Provider business mailing address

4530 E SHEA BLVD STE 180
PHOENIX AZ
85028-6042
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3205
  • Fax: 602-938-5799
Mailing address:
  • Phone: 602-264-4834
  • Fax: 602-254-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number73956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: