Healthcare Provider Details

I. General information

NPI: 1447987250
Provider Name (Legal Business Name): CHASE MEILLEUR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 N 90TH PL
SCOTTSDALE AZ
85258-5067
US

IV. Provider business mailing address

9735 N 90TH PL
SCOTTSDALE AZ
85258-5067
US

V. Phone/Fax

Practice location:
  • Phone: 480-222-4954
  • Fax: 480-210-5460
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10414
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: