Healthcare Provider Details

I. General information

NPI: 1336787894
Provider Name (Legal Business Name): NEPTUNE MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 N 94TH DR # D-1
PEORIA AZ
85381-4836
US

IV. Provider business mailing address

13660 N 94TH DR
PEORIA AZ
85381-4836
US

V. Phone/Fax

Practice location:
  • Phone: 623-230-2912
  • Fax:
Mailing address:
  • Phone: 623-230-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL L BANGART
Title or Position: PROVIDER
Credential: DPM
Phone: 602-595-7228