Healthcare Provider Details

I. General information

NPI: 1790879799
Provider Name (Legal Business Name): JOHN L COUVARAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9817 N 95TH ST BLDG I-105
SCOTTSDALE AZ
85258-4587
US

IV. Provider business mailing address

PO BOX 52001
PHOENIX AZ
85072-2001
US

V. Phone/Fax

Practice location:
  • Phone: 602-765-2229
  • Fax: 602-493-6641
Mailing address:
  • Phone: 602-765-2229
  • Fax: 602-493-6641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberAZ20957
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: