Healthcare Provider Details

I. General information

NPI: 1932471323
Provider Name (Legal Business Name): JOHN C. LINCOLN GENETICS CANCER RISK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19646 N 27TH AVE STE. 201
PHOENIX AZ
85027-4017
US

IV. Provider business mailing address

2500 W UTOPIA RD STE. 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 623-580-5390
  • Fax: 623-580-5397
Mailing address:
  • Phone: 623-434-6200
  • Fax: 623-780-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number4612
License Number StateAZ

VIII. Authorized Official

Name: NATHAN ANSPACH
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 623-780-3751