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General NPI Number Information
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NPI Number | 1487997763
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Entity Type | Individual
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Provider Name | EZEKIEL JOHN ANDERSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 18205 N 51ST AVE STE 109
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City | GLENDALE
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State | AZ
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Zip | 85308-1491
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Country | US
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Telephone | 602-547-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 23363 N 61ST DR
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City | GLENDALE
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State | AZ
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Zip | 85310-5736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 007195
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License Number State | AZ
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