Healthcare Provider Details

I. General information

NPI: 1194810127
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST #130
PHOENIX AZ
85020-4347
US

IV. Provider business mailing address

7600 N 15TH ST #130
PHOENIX AZ
85020-4347
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-1611
  • Fax: 602-371-8929
Mailing address:
  • Phone: 602-861-1611
  • Fax: 602-371-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID RALPH LERSCH
Title or Position: PRESIDENT
Credential: MD
Phone: 602-861-1611