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General NPI Number Information
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NPI Number | 1518603968
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Entity Type | Organization
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Legal Business Name | PARADIGM ANESTHESIA LLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 14050 N 83RD AVE STE 290
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City | PEORIA
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State | AZ
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Zip | 85381-5650
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Country | US
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Telephone | 661-529-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 N 83RD AVE STE 290
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City | PEORIA
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State | AZ
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Zip | 85381-5650
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Country | US
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Telephone | 661-529-2885
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW WALL
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Credential | DDS
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Telephone | 661-529-2885
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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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