Basic Information
| Provider Information | |||||||||
| NPI: | 1770025439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA UROLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13555 W MCDOWELL RD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235124390 | ||||||||
| FaxNumber: | 6235124391 | ||||||||
| Practice Location | |||||||||
| Address1: | 13555 W MCDOWELL RD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235124390 | ||||||||
| FaxNumber: | 6235124391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2016 | ||||||||
| LastUpdateDate: | 11/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAIN | ||||||||
| AuthorizedOfficialFirstName: | PANKAJ | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6235124390 | ||||||||
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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 | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.