Healthcare Provider Details

I. General information

NPI: 1518960996
Provider Name (Legal Business Name): ANDRZEJ DMOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST SUITE 301
PHOENIX AZ
85006-2848
US

IV. Provider business mailing address

1300 N 12TH ST SUITE 301
PHOENIX AZ
85006-2848
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-6968
  • Fax: 602-239-4144
Mailing address:
  • Phone: 602-239-6968
  • Fax: 602-239-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME79755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: