Healthcare Provider Details

I. General information

NPI: 1912167776
Provider Name (Legal Business Name): SOUTHWEST PEDIATRIC ENDOCRINOLOGY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST SUITE B-220
SCOTTSDALE AZ
85258-5054
US

IV. Provider business mailing address

9700 N 91ST ST SUITE B-220
SCOTTSDALE AZ
85258-5054
US

V. Phone/Fax

Practice location:
  • Phone: 480-323-4800
  • Fax: 480-323-4959
Mailing address:
  • Phone: 480-323-4800
  • Fax: 480-323-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number14947
License Number StateAZ

VIII. Authorized Official

Name: DR. ALVIN H. PERELMAN
Title or Position: MEMBER
Credential: M.D.
Phone: 480-323-4800