Healthcare Provider Details

I. General information

NPI: 1801063755
Provider Name (Legal Business Name): DAVID VANLIEROP P L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 16TH ST STE 150
PHOENIX AZ
85020-4431
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
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 Number34921
License Number StateAZ

VIII. Authorized Official

Name: MRS. SHANNON WHITE
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-395-0718