Healthcare Provider Details

I. General information

NPI: 1972783785
Provider Name (Legal Business Name): JAMES J. BOUZOUKIS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 E BELL RD
SCOTTSDALE AZ
85260-1521
US

IV. Provider business mailing address

9155 E BELL RD
SCOTTSDALE AZ
85260-1521
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-8877
  • Fax: 480-889-8878
Mailing address:
  • Phone: 480-889-8877
  • Fax: 480-889-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number30243
License Number StateAZ

VIII. Authorized Official

Name: DR. JAMES J. BOUZOUKIS
Title or Position: MEMBER/OWNER
Credential: MD
Phone: 480-889-8877