Healthcare Provider Details

I. General information

NPI: 1316064363
Provider Name (Legal Business Name): STEVEN ADLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W GREENWAY RD STE 125
PHOENIX AZ
85023-4226
US

IV. Provider business mailing address

2525 W GREENWAY RD STE 125
PHOENIX AZ
85023-4226
US

V. Phone/Fax

Practice location:
  • Phone: 480-640-0513
  • Fax: 602-532-7997
Mailing address:
  • Phone: 480-640-0513
  • Fax: 602-532-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1545
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: