Healthcare Provider Details

I. General information

NPI: 1699270611
Provider Name (Legal Business Name): CODY BOONE MCLEOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 04/18/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 N 40TH ST STE 103
PHOENIX AZ
85018-2158
US

IV. Provider business mailing address

4642 N 31ST ST
PHOENIX AZ
85016-5013
US

V. Phone/Fax

Practice location:
  • Phone: 602-952-8111
  • Fax:
Mailing address:
  • Phone: 870-403-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE13754
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number69200
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: