Healthcare Provider Details

I. General information

NPI: 1831560176
Provider Name (Legal Business Name): CAMELBACK ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 E SOUTHERN AVE STE 1
TEMPE AZ
85282-7612
US

IV. Provider business mailing address

2421 E SOUTHERN AVE STE 1
TEMPE AZ
85282-7612
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-2160
  • Fax: 480-351-8797
Mailing address:
  • Phone: 480-425-2160
  • Fax: 480-351-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number19985
License Number StateAZ

VIII. Authorized Official

Name: DR. GREGG MARTIN CITRON
Title or Position: PHYSICIAN
Credential: MD
Phone: 480-425-2160