Healthcare Provider Details

I. General information

NPI: 1316128085
Provider Name (Legal Business Name): LINDSTROM OB GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S. DOBSON RD SUITE 202
MESA AZ
85202
US

IV. Provider business mailing address

2204 S. DOBSON RD. SUITE 202
MESA AZ
85202
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-6868
  • Fax: 480-633-6996
Mailing address:
  • Phone: 480-633-6868
  • Fax: 480-633-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17253
License Number StateAZ

VIII. Authorized Official

Name: JOSEPH CHANDLER LINDSTROM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 480-633-6868