Healthcare Provider Details

I. General information

NPI: 1417019787
Provider Name (Legal Business Name): LIFESCAPE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8757 E BELL RD
SCOTTSDALE AZ
85260-1322
US

IV. Provider business mailing address

8757 E BELL RD
SCOTTSDALE AZ
85260-1322
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-5500
  • Fax: 480-860-5260
Mailing address:
  • Phone: 480-860-5500
  • Fax: 480-860-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number35591
License Number StateAZ

VIII. Authorized Official

Name: NORMAN J BIZON
Title or Position: PHYSICIANS ASSISTANT
Credential: PA
Phone: 480-860-5500