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General NPI Number Information
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NPI Number | 1588613707
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Entity Type | Individual
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Provider Name | JOHN C AVERY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 1840 E BROADWAY RD
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City | TEMPE
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State | AZ
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Zip | 85282-1614
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Country | US
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Telephone | 602-243-7277
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Fax | 480-927-1092
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Provider Business Mailing Address
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Address Line | 3003 N CENTRAL AVE STE 1600
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City | PHOENIX
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State | AZ
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Zip | 85012-2908
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Country | US
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Telephone | 602-323-3344
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Fax | 602-323-3496
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12048
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4409
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License Number State | AZ
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