Healthcare Provider Details

I. General information

NPI: 1689626624
Provider Name (Legal Business Name): CAVANAGH ANESTHESIA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE SUITE 142
PHOENIX AZ
85013-3449
US

IV. Provider business mailing address

PO BOX 36680
PHOENIX AZ
85067-6680
US

V. Phone/Fax

Practice location:
  • Phone: 209-956-7732
  • Fax: 602-234-3748
Mailing address:
  • Phone: 602-234-1803
  • Fax: 602-234-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HARRY J CAVANAGH JR.
Title or Position: OWNER
Credential: M.D.
Phone: 602-600-6592