Healthcare Provider Details

I. General information

NPI: 1104019413
Provider Name (Legal Business Name): ADULT GASTROENTEROLOGY, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 W BETHANY HOME RD SUITE 2
PHOENIX AZ
85015-1934
US

IV. Provider business mailing address

PO BOX 27340
PHOENIX AZ
85061-7340
US

V. Phone/Fax

Practice location:
  • Phone: 602-550-6354
  • Fax: 602-242-9220
Mailing address:
  • Phone: 602-943-9200
  • Fax: 602-216-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30881
License Number StateAZ

VIII. Authorized Official

Name: NADIM T. ZYADEH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-550-6354