Basic Information
| Provider Information | |||||||||
| NPI: | 1376513291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSTITUTE FOR BONE AND JOINT DISORDERS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1928 E HIGHLAND AVE | ||||||||
| Address2: | STE F104 PMB 443 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025533113 | ||||||||
| FaxNumber: | 6026677991 | ||||||||
| Practice Location | |||||||||
| Address1: | 2122 E HIGHLAND AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025533113 | ||||||||
| FaxNumber: | 6026677991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 03/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6025533113 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0848050003 | 01 | AZ | PTAN | OTHER |