Healthcare Provider Details

I. General information

NPI: 1245270230
Provider Name (Legal Business Name): ALLAN M WACHTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 S WARNER ELLIOT LOOP SUITE 124
PHOENIX AZ
85044-2700
US

IV. Provider business mailing address

12020 S WARNER ELLIOT LOOP SUITE 124
PHOENIX AZ
85044-2700
US

V. Phone/Fax

Practice location:
  • Phone: 480-785-8000
  • Fax: 480-705-8129
Mailing address:
  • Phone: 480-785-8000
  • Fax: 480-705-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number17145
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number17145
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: