Healthcare Provider Details

I. General information

NPI: 1609840537
Provider Name (Legal Business Name): MARK ROBERT HEMPHILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 S LAKESHORE DR SUITE 1
TEMPE AZ
85282-7161
US

IV. Provider business mailing address

1841 E NORTHVIEW AVE
PHOENIX AZ
85020-5241
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-9797
  • Fax: 480-838-9444
Mailing address:
  • Phone: 602-906-0041
  • Fax: 480-838-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAZ24566
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: