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General NPI Number Information
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NPI Number | 1336667450
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Entity Type | Organization
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Legal Business Name | VINCERE CANCER LLC
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 7469 E MONTE CRISTO AVE
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1618
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Country | US
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Telephone | 480-659-0606
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Fax | 602-331-5886
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Provider Business Mailing Address
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Address Line | PO BOX 207433
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City | DALLAS
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State | TX
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Zip | 75320-7429
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Country | US
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Telephone | 480-625-0003
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Fax | 480-842-8760
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | PABLO PRICHARD
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Credential | MD
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Telephone | 602-331-7811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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