Healthcare Provider Details

I. General information

NPI: 1336121102
Provider Name (Legal Business Name): SCOTT WILLIAM SIVERHUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18444 N 25TH AVE STE 210
PHOENIX AZ
85023-1264
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-5600
  • Fax: 866-939-2673
Mailing address:
  • Phone: 623-573-5600
  • Fax: 866-939-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37682
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number37682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: