Healthcare Provider Details

I. General information

NPI: 1891963195
Provider Name (Legal Business Name): BARBARA FONG MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14506 W GRANITE VALLEY DR SUITE 117
SUN CITY WEST AZ
85375-6010
US

IV. Provider business mailing address

PO BOX 7118
CHANDLER AZ
85246-7118
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-1521
  • Fax:
Mailing address:
  • Phone: 480-899-1711
  • Fax: 480-857-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15294
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number15294
License Number StateAZ

VIII. Authorized Official

Name: DR. BARBARA MEL FONG
Title or Position: OWNER
Credential: MD
Phone: 623-544-1521