Healthcare Provider Details

I. General information

NPI: 1225038458
Provider Name (Legal Business Name): PAUL MICHAEL BLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD B200
GLENDALE AZ
85306-4660
US

IV. Provider business mailing address

5750 W THUNDERBIRD RD B200
GLENDALE AZ
85306-4660
US

V. Phone/Fax

Practice location:
  • Phone: 602-375-1700
  • Fax: 602-978-1225
Mailing address:
  • Phone: 602-375-1700
  • Fax: 602-978-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13694
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: