Healthcare Provider Details

I. General information

NPI: 1114583291
Provider Name (Legal Business Name): STEVEN K STRUTHERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 11/30/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 HIGHWAY 260 STE 103
LAKESIDE AZ
85929-5851
US

IV. Provider business mailing address

4830 HIGHWAY 260 STE 103
LAKESIDE AZ
85929-5851
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-8777
  • Fax: 928-537-1914
Mailing address:
  • Phone: 928-537-8777
  • Fax: 928-537-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: