Basic Information
| Provider Information | |||||||||
| NPI: | 1104019413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADULT GASTROENTEROLOGY, P.L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27340 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850617340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029439200 | ||||||||
| FaxNumber: | 6022163026 | ||||||||
| Practice Location | |||||||||
| Address1: | 2236 W BETHANY HOME RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850151934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025506354 | ||||||||
| FaxNumber: | 6022429220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZYADEH | ||||||||
| AuthorizedOfficialFirstName: | NADIM | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6025506354 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 30881 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.