Healthcare Provider Details

I. General information

NPI: 1477848703
Provider Name (Legal Business Name): JULIE EILEEN DRICKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 204
PHOENIX AZ
85032-3356
US

IV. Provider business mailing address

16601 N 40TH ST STE 204
PHOENIX AZ
85032-3356
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-3721
  • Fax: 602-953-5466
Mailing address:
  • Phone: 602-633-3721
  • Fax: 602-953-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA131243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL3784R
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number78157
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD60832688
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: