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General NPI Number Information
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NPI Number | 1467829184
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Entity Type | Organization
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Legal Business Name | AZ SPORTS CLINIC, LLC
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 7797 W. PARADISE LANE SUITE 130
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City | PHOENIX
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State | AZ
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Zip | 85382-3588
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Country | US
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Telephone | 623-547-7502
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Fax | 623-414-3503
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Provider Business Mailing Address
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Address Line | 7797 W. PARADISE LANE SUITE 130
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-547-7502
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Fax | 623-414-3503
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANA G. SELTZER
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Credential | M.D.
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Telephone | 623-547-7502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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