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General NPI Number Information
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NPI Number | 1881879328
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Entity Type | Organization
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Legal Business Name | OBSTETRICS & GYNECOLOGY CONSULTANTS PC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 6036 N 19TH AVE #401
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City | PHOENIX
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State | AZ
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Zip | 85015
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Country | US
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Telephone | 602-249-1377
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Fax | 602-249-4908
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Provider Business Mailing Address
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Address Line | 6036 N 19TH AVE #401
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City | PHOENIX
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State | AZ
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Zip | 85015
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Country | US
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Telephone | 602-249-1377
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Fax | 602-249-4908
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICAH S HARRIS
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Credential | M.D.
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Telephone | 602-249-1377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21602
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License Number State | AZ
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