Healthcare Provider Details

I. General information

NPI: 1982686747
Provider Name (Legal Business Name): ERUM MUMTAZ NOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

14616 N 28TH ST
PHOENIX AZ
85032-4928
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-997-0423
  • Fax: 623-321-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number30831
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: