Healthcare Provider Details

I. General information

NPI: 1730790080
Provider Name (Legal Business Name): MADISON MEDICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W LAS PALMARITAS DR
PHOENIX AZ
85021-5546
US

IV. Provider business mailing address

911 W LAS PALMARITAS DR
PHOENIX AZ
85021-5546
US

V. Phone/Fax

Practice location:
  • Phone: 602-505-0667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SHORES
Title or Position: PARTNER
Credential: MD
Phone: 480-414-9868