Healthcare Provider Details

I. General information

NPI: 1255310462
Provider Name (Legal Business Name): MARK JAMES SYMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 N 3RD ST SUITE 201
PHOENIX AZ
85004-1113
US

IV. Provider business mailing address

2627 N 3RD ST SUITE 201
PHOENIX AZ
85004-1113
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-9919
  • Fax: 602-307-5905
Mailing address:
  • Phone: 602-307-9919
  • Fax: 602-307-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number30210
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: