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General NPI Number Information
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NPI Number | 1659471555
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Entity Type | Individual
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Provider Name | WILL INNOCENT M.D
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 515 W BUCKEYE RD SUITE 303
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City | PHOENIX
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State | AZ
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Zip | 85003-2647
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Country | US
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Telephone | 602-374-5353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10176
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City | GLENDALE
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State | AZ
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Zip | 85318-0176
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME92937
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License Number State | FL
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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 | 32113
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License Number State | AZ
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