Healthcare Provider Details

I. General information

NPI: 1497853733
Provider Name (Legal Business Name): MARK A. MATHURIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MILL AVE EMERGENCY DEPARTMENT
TEMPE AZ
85281-6699
US

IV. Provider business mailing address

861 SW 78TH AVE #100B
PLANTATION FL
33324-3273
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-5533
  • Fax: 480-333-5197
Mailing address:
  • Phone: 954-693-0000
  • Fax: 954-693-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number23700
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23700
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: