Healthcare Provider Details

I. General information

NPI: 1265897268
Provider Name (Legal Business Name): MARK A GREENFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 N 35TH AVE
PHOENIX AZ
85053-7640
US

IV. Provider business mailing address

15830 N 35TH AVE
PHOENIX AZ
85053-7640
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-1188
  • Fax: 602-866-3036
Mailing address:
  • Phone: 602-298-1188
  • Fax: 602-866-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number6295
License Number StateAZ

VIII. Authorized Official

Name: DR. MARK A GREENFIELD
Title or Position: ORTHOPEDIC SURGEON
Credential: D.O.
Phone: 602-298-1188