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General NPI Number Information
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NPI Number | 1972832707
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE EXPRESS PLLC
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 2875 W RAY RD SUITE 8
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City | CHANDLER
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State | AZ
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Zip | 85224-3524
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Country | US
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Telephone | 480-726-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 W RAY RD SUITE 6, BOX #405
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City | CHANDLER
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State | AZ
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Zip | 85224-3524
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Country | US
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Telephone | 480-726-3440
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MATTHEW SHORES
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Credential | M.D.
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Telephone | 480-726-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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