=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689848590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN J. LINSTROM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2008
-----------------------------------------------------
Last Update Date | 08/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37000 N GANTZEL RD
-----------------------------------------------------
City | SAN TAN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85140-7303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-394-4031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 W BROWN RD 9N-05
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85201-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-684-5066
-----------------------------------------------------
Fax | 480-684-5027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 34145
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------