Healthcare Provider Details

I. General information

NPI: 1528297306
Provider Name (Legal Business Name): SAMUEL MARK HARMSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE SUITE 300
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

2222 E HIGHLAND AVE SUITE 300
PHOENIX AZ
85016-4872
US

V. Phone/Fax

Practice location:
  • Phone: 602-512-8558
  • Fax:
Mailing address:
  • Phone: 602-512-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR71548
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: