Healthcare Provider Details

I. General information

NPI: 1285022111
Provider Name (Legal Business Name): RICHARD ALAN ISENBERG M.D., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1258
RIDGWAY CO
81432-1258
US

IV. Provider business mailing address

7530 E ANGUS DR
SCOTTSDALE AZ
85251-6410
US

V. Phone/Fax

Practice location:
  • Phone: 520-276-4070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number40551
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-0018287
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40551
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number40551
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number40551
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: