Healthcare Provider Details

I. General information

NPI: 1851364996
Provider Name (Legal Business Name): STEVEN BRADLEY CHINTIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E THOMAS RD
PHOENIX AZ
85016-7711
US

IV. Provider business mailing address

PO BOX 11720
PRESCOTT AZ
86304-1720
US

V. Phone/Fax

Practice location:
  • Phone: 602-532-1000
  • Fax:
Mailing address:
  • Phone: 928-771-5470
  • Fax: 928-771-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2583
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2583
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: