Healthcare Provider Details

I. General information

NPI: 1679716542
Provider Name (Legal Business Name): ARIZONA MEDICAL VEIN CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 S MCCLINTOCK DR SUITE 101
TEMPE AZ
85282-7376
US

IV. Provider business mailing address

4515 S MCCLINTOCK DR SUITE 101
TEMPE AZ
85282-7376
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-6455
  • Fax:
Mailing address:
  • Phone: 480-860-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES ROGERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-860-6455