Healthcare Provider Details

I. General information

NPI: 1114911674
Provider Name (Legal Business Name): JOSHUA W REEDY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N 24TH ST STE 210
PHOENIX AZ
85016-6536
US

IV. Provider business mailing address

3700 N 24TH ST STE 210
PHOENIX AZ
85016-6536
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-0681
  • Fax: 602-957-1570
Mailing address:
  • Phone: 602-840-0681
  • Fax: 602-957-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3238
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: