Healthcare Provider Details

I. General information

NPI: 1417430612
Provider Name (Legal Business Name): MMT SURGICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD STE 140
SCOTTSDALE AZ
85251-5649
US

IV. Provider business mailing address

3501 N SCOTTSDALE RD STE 140
SCOTTSDALE AZ
85251-5649
US

V. Phone/Fax

Practice location:
  • Phone: 631-827-8159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: MATHEW JAMES
Title or Position: PATIENT ACCOUNTS
Credential:
Phone: 631-827-8159