Healthcare Provider Details

I. General information

NPI: 1831257575
Provider Name (Legal Business Name): CAMELBACK PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E CAMELBACK ROAD SUITE G100
PHOENIX AZ
85018-2720
US

IV. Provider business mailing address

4350 E CAMELBACK ROAD SUITE G100
PHOENIX AZ
85018-2720
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-3120
  • Fax: 602-840-3237
Mailing address:
  • Phone: 602-840-3120
  • Fax: 602-840-3237

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 R ALEXANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 602-840-3120