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General NPI Number Information
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NPI Number | 1205185220
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Entity Type | Organization
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Legal Business Name | PHOENIX HEAD AND NECK SURGERY LTD
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 4250 E CAMELBACK RD STE K250
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City | PHOENIX
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State | AZ
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Zip | 85018-2777
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Country | US
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Telephone | 602-254-9398
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 E CAMELBACK RD STE K250
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City | PHOENIX
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State | AZ
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Zip | 85018-2777
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Country | US
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Telephone | 602-254-9398
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Fax |
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Authorized Official
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Title or Position | SURGEON
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Name | DR. MARK E. BALDREE
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Credential | M.D.
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Telephone | 602-254-9398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 12576
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License Number State | AZ
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