Healthcare Provider Details

I. General information

NPI: 1598112831
Provider Name (Legal Business Name): RICHARD LEE AVERITTE JR., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13995 W STATLER BLVD SUITE 150
SURPRISE AZ
85374-5501
US

IV. Provider business mailing address

20401 N 73RD ST SUITE 230
SCOTTSDALE AZ
85255-4153
US

V. Phone/Fax

Practice location:
  • Phone: 480-223-6843
  • Fax: 480-223-6851
Mailing address:
  • Phone: 480-556-0446
  • Fax: 480-223-6954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number3866
License Number StateAZ

VIII. Authorized Official

Name: MARLIE AVERITTE
Title or Position: CFO
Credential:
Phone: 480-556-0446