Healthcare Provider Details

I. General information

NPI: 1912938655
Provider Name (Legal Business Name): ARIZONA UROLOGY AND INFERTILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD
GLENDALE AZ
85306-4641
US

IV. Provider business mailing address

5757 W THUNDERBIRD RD
GLENDALE AZ
85306-4641
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL M BLOCK, MD
Title or Position: ADMINISTRATOR/OWNER
Credential: MD
Phone: 602-395-0718