Healthcare Provider Details

I. General information

NPI: 1770025439
Provider Name (Legal Business Name): ARIZONA UROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 W MCDOWELL RD STE 302
GOODYEAR AZ
85395-2629
US

IV. Provider business mailing address

13555 W MCDOWELL RD STE 302
GOODYEAR AZ
85395-2629
US

V. Phone/Fax

Practice location:
  • Phone: 623-512-4390
  • Fax: 623-512-4391
Mailing address:
  • Phone: 623-512-4390
  • Fax: 623-512-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. PANKAJ M JAIN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 623-512-4390