Healthcare Provider Details

I. General information

NPI: 1346417466
Provider Name (Legal Business Name): MACIAS OTOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 E MCDOWELL RD STE 208
PHOENIX AZ
85006-2508
US

IV. Provider business mailing address

926 E MCDOWELL RD STE 208
PHOENIX AZ
85006-2508
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-4228
  • Fax: 602-252-6416
Mailing address:
  • Phone: 602-257-4228
  • Fax: 602-252-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22346
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number22346
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number22346
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN DAVID MACIAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-257-4228