MEDICARE: DR. ROYAL B. ANSPACH M.D.

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
1	207Q00000X	Family Medicine Physician	8995	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1306805338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROYAL B. ANSPACH M.D.

Provider Business Mailing Address
First Line	:	26224 N TATUM BLVD
Second Line	:	#15A
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7500
Country	:	US
Telephone Number	:	480-663-9632
Fax Number	:	480-419-6782

Provider Business Practice Location Address
First Line	:	26224 N TATUM BLVD
Second Line	:	#15A
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7500
Country	:	US
Telephone Number	:	480-663-9632
Fax Number	:	480-419-6782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/07/2010

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