Healthcare Provider Details

I. General information

NPI: 1396905444
Provider Name (Legal Business Name): ROBERT SIMMONDS MINDELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2762 E. YALE ST.
PHOENIX AZ
85008
US

IV. Provider business mailing address

2762 E. YALE ST.
PHOENIX AZ
85008
US

V. Phone/Fax

Practice location:
  • Phone: 480-707-2292
  • Fax:
Mailing address:
  • Phone: 480-707-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number18971
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number6168743-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: