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General NPI Number Information
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NPI Number | 1265756977
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Entity Type | Organization
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Legal Business Name | PHOENIX DIABETES AND ENDOCRINOLOGY, LLC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 4045 E UNION HILLS DR A107
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City | PHOENIX
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State | AZ
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Zip | 85050-3386
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Country | US
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Telephone | 602-788-3636
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Fax | 602-788-3646
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Provider Business Mailing Address
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Address Line | 4045 E UNION HILLS DR A-107
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City | PHOENIX
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State | AZ
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Zip | 85050-3386
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Country | US
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Telephone | 602-788-3636
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Fax | 602-788-3646
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. CAROLE D BAKER
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Credential |
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Telephone | 602-788-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 25915
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License Number State | AZ
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