Healthcare Provider Details

I. General information

NPI: 1326090796
Provider Name (Legal Business Name): PAUL ROBERT HLADON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MOHAVE RD EMERGENCY DEPARTMENT
PARKER AZ
85344-6349
US

IV. Provider business mailing address

5151 E GUADALUPE RD #1073
PHOENIX AZ
85044-7710
US

V. Phone/Fax

Practice location:
  • Phone: 800-444-7009
  • Fax: 800-305-3233
Mailing address:
  • Phone: 480-773-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34890
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: