=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376508143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH SCOTTSDALE PLASTIC SURGERY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9377 E BELL RD #307
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-502-5755
-----------------------------------------------------
Fax | 480-502-5736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9377 E BELL RD #307
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-502-5755
-----------------------------------------------------
Fax | 480-502-5736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN LEONARD WILLIAMS JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-502-5755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 27563
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------