Healthcare Provider Details

I. General information

NPI: 1215285010
Provider Name (Legal Business Name): ELLIOT BLAU, DO, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 E OSBORN RD
SCOTTSDALE AZ
85251-6325
US

IV. Provider business mailing address

7002 E OSBORN RD
SCOTTSDALE AZ
85251-6325
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-7609
  • Fax: 480-947-5341
Mailing address:
  • Phone: 480-947-7609
  • Fax: 480-947-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number846
License Number StateAZ

VIII. Authorized Official

Name: DR. ELLIOT BLAU
Title or Position: PRESIDENT
Credential: DO
Phone: 480-947-7609