Healthcare Provider Details

I. General information

NPI: 1649290446
Provider Name (Legal Business Name): ARIZONA WOUND CARE & HYPERBARIC MEDICINE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD
PHOENIX AZ
85032-2138
US

IV. Provider business mailing address

PO BOX 80073
CITY OF INDUSTRY CA
91716-8073
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-5764
  • 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/OWNER
Credential: MD
Phone: 818-340-9988