Healthcare Provider Details

I. General information

NPI: 1063419661
Provider Name (Legal Business Name): WILLIAM G SCHWARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE SUITE 106
PHOENIX AZ
85022
US

IV. Provider business mailing address

13951 N SCOTTSDALE RD SUITE 211
SCOTTSDALE AZ
85254-3402
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-9300
  • Fax: 480-609-9350
Mailing address:
  • Phone: 480-609-9300
  • Fax: 480-609-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: