Healthcare Provider Details

I. General information

NPI: 1306278403
Provider Name (Legal Business Name): ARIZONA COLORECTAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD STE 222
SCOTTSDALE AZ
85251-5649
US

IV. Provider business mailing address

3501 N SCOTTSDALE RD STE 222
SCOTTSDALE AZ
85251-5649
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-3533
  • Fax:
Mailing address:
  • Phone: 480-947-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number005056
License Number StateAZ

VIII. Authorized Official

Name: SUSAN GARAND
Title or Position: PHYSICIAN
Credential: DO
Phone: 480-947-3533