Healthcare Provider Details

I. General information

NPI: 1972896918
Provider Name (Legal Business Name): MIDTOWN ENDOCRINE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N 3RD ST
PHOENIX AZ
85004-1401
US

IV. Provider business mailing address

2200 N 3RD ST
PHOENIX AZ
85004-1401
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-9955
  • Fax: 602-258-9933
Mailing address:
  • Phone: 602-258-9955
  • Fax: 602-258-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA221768
License Number StateAZ

VIII. Authorized Official

Name: JOAN F BAILEY
Title or Position: JOAN F BAILEY M.D. P.C.
Credential: M.D.
Phone: 602-258-9955