Healthcare Provider Details

I. General information

NPI: 1851557300
Provider Name (Legal Business Name): EDWARD JACK SAYEGH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N 3RD ST
PHOENIX AZ
85004-1104
US

IV. Provider business mailing address

2601 N 3RD ST
PHOENIX AZ
85004-1104
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-5359
  • Fax:
Mailing address:
  • Phone: 602-264-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40787
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: