Basic Information
| Provider Information | |||||||||
| NPI: | 1043204894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERHOOGEN | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18444 N 25TH AVE | ||||||||
| Address2: | STE 310 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850231266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669742673 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Practice Location | |||||||||
| Address1: | 4485 S I-19 FRONTAGE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669742673 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 48715 | AZ | N | Other Service Providers | Specialist | 207X00000X | MD00011013 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 35-092544 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 48715 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208600000X | 48715 | AZ | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1066307 | 05 | WA | MEDICAID | 008582 | 05 | AZ | MEDICAID | P00186936 | 01 | WA | RR MEDICARE | OTHER |