Healthcare Provider Details

I. General information

NPI: 1790780393
Provider Name (Legal Business Name): LORY ELLEN BARAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD STE 4100
PHOENIX AZ
85032-2167
US

IV. Provider business mailing address

3815 E BELL RD STE 4500
PHOENIX AZ
85032-2171
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5040
  • Fax: 602-494-4020
Mailing address:
  • Phone: 602-633-3838
  • Fax: 602-633-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25915
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: