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General NPI Number Information
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NPI Number | 1932255791
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Entity Type | Organization
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Legal Business Name | COPPER STATE ORTHOPEDICS, LTD
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 04/21/2008
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Provider Practice Location Address
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Address Line | 1002 E MCDOWELL RD SUITE A
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City | PHOENIX
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State | AZ
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Zip | 85006-2625
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Country | US
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Telephone | 602-262-2663
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Fax | 602-258-3008
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Provider Business Mailing Address
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Address Line | 1002 E MCDOWELL RD SUITE A
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City | PHOENIX
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State | AZ
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Zip | 85006-2625
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Country | US
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Telephone | 602-262-2663
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Fax | 602-258-3008
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHAR L MANLEY
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Credential |
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Telephone | 602-262-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 22049
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License Number State | AZ
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