Healthcare Provider Details

I. General information

NPI: 1336868934
Provider Name (Legal Business Name): M L ROPER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 290
PHOENIX AZ
85020-4336
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 23-950-7186
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-395-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VANESSA KOZIOL
Title or Position: CREDENTIALING
Credential:
Phone: 602-395-0718