Healthcare Provider Details

I. General information

NPI: 1740842798
Provider Name (Legal Business Name): COURTNEY MARIE GRZYBOWSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY MARIE MARTIN DO

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

V. Phone/Fax

Practice location:
  • Phone: 480-285-8022
  • Fax:
Mailing address:
  • Phone: 480-285-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number009573
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number009573
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: