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NPI Code Detail

MEDICARE: ARIZONA EMERGENCY SPECIALIST, PC

MEDICARE: ARIZONA EMERGENCY SPECIALIST, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AZ0306240OTHERAZBLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063446227
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARIZONA EMERGENCY SPECIALIST, PC
Provider Business Mailing Address
First Line : PO BOX 80072
Second Line :
City : CITY OF INDUSTRY
State : CA
Zip : 91716-8072
Country : US
Telephone Number : 818-340-9988
Fax Number : 818-587-2493
Provider Business Practice Location Address
First Line : 3929 E BELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-2112
Country : US
Telephone Number : 602-923-5000
Fax Number : 818-587-2493
Authorized Official
Title or Position : PRESIDENT
Name : ROGER A WILLCOX
Credential : MD
Telephone Number : 602-923-5000
Provider Enumeration Date : 07/11/2006
Last Update Date : 08/22/2020

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