Healthcare Provider Details

I. General information

NPI: 1508997719
Provider Name (Legal Business Name): FIFTH AVENUE GYNECOLOGISTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W BELL RD STE 100
PHOENIX AZ
85053-3000
US

IV. Provider business mailing address

3033 W BELL RD STE 100
PHOENIX AZ
85053-3000
US

V. Phone/Fax

Practice location:
  • Phone: 602-588-0316
  • Fax: 602-588-0463
Mailing address:
  • Phone: 602-588-0316
  • Fax: 602-588-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4287
License Number StateAZ

VIII. Authorized Official

Name: DR. RICHARD C ZACHER
Title or Position: PRESIDENT
Credential: MD
Phone: 602-588-0316