Healthcare Provider Details

I. General information

NPI: 1275512352
Provider Name (Legal Business Name): JEFFREY STUART KATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 W NORTHERN AVE 108
PHOENIX AZ
85021-5472
US

IV. Provider business mailing address

1715 W NORTHERN AVE 108
PHOENIX AZ
85021-5472
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22827
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: