Healthcare Provider Details

I. General information

NPI: 1255327474
Provider Name (Legal Business Name): STEVEN P LAITIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11024 N 28TH DR SUITE 160
PHOENIX AZ
85029-4377
US

IV. Provider business mailing address

PO BOX 72090
PHOENIX AZ
85050-1019
US

V. Phone/Fax

Practice location:
  • Phone: 480-361-7680
  • Fax: 480-361-7683
Mailing address:
  • Phone: 480-361-7680
  • Fax: 480-361-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24192
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number24192
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number24192
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24192
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: