Healthcare Provider Details

I. General information

NPI: 1063446227
Provider Name (Legal Business Name): ARIZONA EMERGENCY SPECIALIST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 E BELL RD
PHOENIX AZ
85032-2112
US

IV. Provider business mailing address

PO BOX 80072
CITY OF INDUSTRY CA
91716-8072
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-5000
  • Fax: 818-587-2493
Mailing address:
  • Phone: 818-340-9988
  • Fax: 818-587-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROGER A WILLCOX
Title or Position: PRESIDENT
Credential: MD
Phone: 602-923-5000