Healthcare Provider Details

I. General information

NPI: 1265539860
Provider Name (Legal Business Name): STEVE FANTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 E DEER VALLEY J100
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

PO BOX 26356
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 480-502-0250
  • Fax: 480-596-2490
Mailing address:
  • Phone: 480-502-0250
  • Fax: 480-596-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number21514
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: