Healthcare Provider Details

I. General information

NPI: 1396097580
Provider Name (Legal Business Name): ABOUT FACE- EAR NOSE & THROAT FACIAL PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9767 N 91ST ST # B102
SCOTTSDALE AZ
85258-5086
US

IV. Provider business mailing address

9767 N 91ST ST # B102
SCOTTSDALE AZ
85258-5086
US

V. Phone/Fax

Practice location:
  • Phone: 480-314-0100
  • Fax: 480-314-1170
Mailing address:
  • Phone: 480-314-0100
  • Fax: 480-314-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberAZ22242
License Number StateAZ

VIII. Authorized Official

Name: ROBERT H WOODS
Title or Position: PRESIDENT
Credential: MD
Phone: 480-314-0100