Basic Information
| Provider Information | |||||||||
| NPI: | 1912190588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022586634 | ||||||||
| FaxNumber: | 6022584311 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022586634 | ||||||||
| FaxNumber: | 6022584311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PERO | ||||||||
| AuthorizedOfficialFirstName: | LURLYN | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 6022586634 | ||||||||
| 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 | 261QP2300X | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.