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General NPI Number Information
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NPI Number | 1487793295
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Entity Type | Organization
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Legal Business Name | MARICOPA EAR NOSE & THROAT P C
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 2131 W SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282
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Country | US
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Telephone | 480-820-1200
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Fax | 480-820-5743
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Provider Business Mailing Address
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Address Line | 2131 W SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282
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Country | US
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Telephone | 480-820-1200
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Fax | 480-820-5743
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THAD E BARTELL
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Credential | MD
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Telephone | 480-820-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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