Healthcare Provider Details

I. General information

NPI: 1255496469
Provider Name (Legal Business Name): GEORGE STAVROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 N 24TH ST
PHOENIX AZ
85016-6512
US

IV. Provider business mailing address

3825 N 24TH ST
PHOENIX AZ
85016-6512
US

V. Phone/Fax

Practice location:
  • Phone: 602-248-8886
  • Fax: 602-248-8999
Mailing address:
  • Phone: 602-248-8886
  • Fax: 602-248-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4409
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: