Healthcare Provider Details

I. General information

NPI: 1700022175
Provider Name (Legal Business Name): HERBER I. SCHUCK N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 N 7TH ST UNIT 220
PHOENIX AZ
85014-1011
US

IV. Provider business mailing address

6767 N 7TH ST UNIT 220
PHOENIX AZ
85014-1011
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-7806
  • Fax: 602-274-0766
Mailing address:
  • Phone: 602-263-7806
  • Fax: 602-274-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number03-730
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: