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General NPI Number Information
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NPI Number | 1578550398
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Entity Type | Individual
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Provider Name | DON B. HEADLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 500 W THOMAS RD SUITE 900
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City | PHOENIX
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State | AZ
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Zip | 85013-4224
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Country | US
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Telephone | 602-406-3540
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Fax | 602-406-7186
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Provider Business Mailing Address
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Address Line | FILE 56765
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City | LOS ANGELES
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State | CA
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Zip | 90074-6765
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Country | US
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Telephone | 602-406-3860
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Fax | 602-406-6132
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 22079
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License Number State | AZ
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