Healthcare Provider Details

I. General information

NPI: 1679682785
Provider Name (Legal Business Name): SCOTT ANDREW HAVENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 E CORONADO RD STE 201
PHOENIX AZ
85004-1583
US

IV. Provider business mailing address

337 E CORONADO RD STE 201
PHOENIX AZ
85004-1583
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-4600
  • Fax: 602-428-7045
Mailing address:
  • Phone: 480-712-4600
  • Fax: 602-428-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33035
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number33035
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33035
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: