Healthcare Provider Details

I. General information

NPI: 1124545934
Provider Name (Legal Business Name): VINCERE PHYSICIANS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7469 E MONTE CRISTO AVE
SCOTTSDALE AZ
85260-1618
US

IV. Provider business mailing address

PO BOX 47340
PHOENIX AZ
85068-7340
US

V. Phone/Fax

Practice location:
  • Phone: 602-331-7811
  • Fax: 602-331-5886
Mailing address:
  • Phone: 602-331-7811
  • Fax: 602-331-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PABLO PRICHARD
Title or Position: SOLE MEMBER
Credential: MD
Phone: 602-331-7811