Healthcare Provider Details

I. General information

NPI: 1588846851
Provider Name (Legal Business Name): PHOENIX SPINE CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19841 N 27TH AVE STE 300A
PHOENIX AZ
85027-4012
US

IV. Provider business mailing address

19841 N 27TH AVE STE 300A
PHOENIX AZ
85027-4012
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-2010
  • Fax:
Mailing address:
  • Phone: 623-582-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number29670
License Number StateAZ

VIII. Authorized Official

Name: JOHN LOUIS BEGHIN
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 623-582-2010