Healthcare Provider Details

I. General information

NPI: 1205837861
Provider Name (Legal Business Name): EDWARD D SZMUC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

6301 S MCCLINTOCK DR STE 215
TEMPE AZ
85283
US

IV. Provider business mailing address

2545 W FRYE RD STE 9
CHANDLER AZ
85224-6273
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-6657
  • Fax: 480-505-3689
Mailing address:
  • Phone: 480-505-4258
  • Fax: 480-275-8346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14022
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: