Healthcare Provider Details

I. General information

NPI: 1619085636
Provider Name (Legal Business Name): PATRICK HARRY DAVID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5011
  • Fax: 602-344-0779
Mailing address:
  • Phone: 602-344-5011
  • Fax: 602-344-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22800
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: