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General NPI Number Information
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NPI Number | 1336120963
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Entity Type | Organization
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Legal Business Name | NORTHERN ARIZONA RADIATION ONCOLOGY
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 1200 N. BEAVER STREET CANCER CENTER OF NORTHERN ARIZONA
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-773-2261
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749560
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City | LOS ANGELES
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State | CA
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Zip | 90074-9560
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Country | US
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Telephone | 770-693-2622
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Fax | 770-693-6039
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW K DAVID
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Credential | M.D.
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Telephone | 928-204-4160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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