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General NPI Number Information
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NPI Number | 1760011514
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Entity Type | Individual
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Provider Name | DR. ALI ETMAN
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Gender | Male
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 1300 N 12TH ST STE 605
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City | PHOENIX
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State | AZ
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Zip | 85006-2850
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Country | US
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Telephone | 602-839-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 S COUNTRY CLUB DR
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City | MESA
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State | AZ
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Zip | 85210-5162
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Country | US
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Telephone | 480-827-5500
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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 | 70200
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License Number State | AZ
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