Healthcare Provider Details

I. General information

NPI: 1447344908
Provider Name (Legal Business Name): ARIZONA TRANSPLANT ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 N 3RD ST
PHOENIX AZ
85004-1401
US

IV. Provider business mailing address

2218 N 3RD ST
PHOENIX AZ
85004-1401
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-2543
  • Fax:
Mailing address:
  • Phone: 602-252-2543
  • Fax: 602-252-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE KOEP
Title or Position: PRESIDENT
Credential: MD
Phone: 602-252-2543