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NPI Code Detail

MEDICARE: JOHN STATHAKIS DO

MEDICARE: JOHN STATHAKIS DO
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
1207N00000XDermatology Physician0999AZ

General Provider Information

NPI Number : 1265426910
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN STATHAKIS DO
Provider Business Mailing Address
First Line : 5056 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1521
Country : US
Telephone Number : 602-222-9111
Fax Number : 602-222-9333
Provider Business Practice Location Address
First Line : 5056 N CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1521
Country : US
Telephone Number : 602-222-9111
Fax Number : 602-222-9333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 07/11/2013

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