Basic Information
| Provider Information | |||||||||
| NPI: | 1437654357 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA MEDICAL PRACTITIONERS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5321 W MISTY WILLOW LN | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853103732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235849985 | ||||||||
| FaxNumber: | 6235849986 | ||||||||
| Practice Location | |||||||||
| Address1: | 5321 W MISTY WILLOW LN | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853103732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235849985 | ||||||||
| FaxNumber: | 6235849986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2018 | ||||||||
| LastUpdateDate: | 03/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | MOSS | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 6235849985 | ||||||||
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| 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 | 207L00000X | 17628 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.