Healthcare Provider Details

I. General information

NPI: 1962612069
Provider Name (Legal Business Name): DAVID G CARFAGNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 N 92ND ST SUITE 102
SCOTTSDALE AZ
85258-4556
US

IV. Provider business mailing address

10133 N 92ND ST SUITE 102
SCOTTSDALE AZ
85258-4556
US

V. Phone/Fax

Practice location:
  • Phone: 623-399-8606
  • Fax: 623-399-9958
Mailing address:
  • Phone: 623-399-8606
  • Fax: 623-399-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number3227
License Number StateAZ

VIII. Authorized Official

Name: DR. DAVID GIRARD CARFAGNO
Title or Position: PHYSICIAN
Credential: DM
Phone: 623-399-8606