Healthcare Provider Details

I. General information

NPI: 1053389957
Provider Name (Legal Business Name): SCOTT D AGRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W ROSE GARDEN LN
PHOENIX AZ
85027-2530
US

IV. Provider business mailing address

2323 W ROSE GARDEN LN
PHOENIX AZ
85027-2530
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-6200
  • Fax: 623-842-5640
Mailing address:
  • Phone: 602-521-6200
  • Fax: 623-842-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number22147
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22147
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: