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General NPI Number Information
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NPI Number | 1225435662
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Entity Type | Organization
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Legal Business Name | MEDEXAZ LLC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 32 SPUR CIR
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5461
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Country | US
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Telephone | 602-284-8265
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Fax |
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Provider Business Mailing Address
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Address Line | 32 SPUR CIR
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5461
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Country | US
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Telephone | 602-284-8265
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | JACK J MITREY
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Credential |
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Telephone | 602-284-8265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1023087293
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1023087293
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 1023087293
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License Number State | AZ
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