Basic Information
| Provider Information | |||||||||
| NPI: | 1366570244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARIZONA EAR CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2627 N 3RD ST | ||||||||
| Address2: | STE.201 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023079919 | ||||||||
| FaxNumber: | 6023075905 | ||||||||
| Practice Location | |||||||||
| Address1: | 2627 N 3RD ST | ||||||||
| Address2: | 201 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023079919 | ||||||||
| FaxNumber: | 6023075905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 02/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | SYMS | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6023079919 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 30210 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.