Healthcare Provider Details

I. General information

NPI: 1881618569
Provider Name (Legal Business Name): SCOT GERALD FECHTEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E MUIRWOOD DR SUITE 111
PHOENIX AZ
85048-7639
US

IV. Provider business mailing address

14611 S 8TH ST
PHOENIX AZ
85048-6342
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2365
  • Fax: 480-961-2382
Mailing address:
  • Phone: 480-460-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number25410
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: