Healthcare Provider Details

I. General information

NPI: 1558363747
Provider Name (Legal Business Name): STEPHEN GLOUBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 2015
PHOENIX AZ
85020-2404
US

IV. Provider business mailing address

3020 E CAMELBACK RD SUITE 301
PHOENIX AZ
85016-5095
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-3575
  • Fax: 602-279-2666
Mailing address:
  • Phone: 602-279-3575
  • Fax: 602-279-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8891
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: