Basic Information
Provider Information
NPI: 1922116409
EntityType: 2
ReplacementNPI:  
OrganizationName: RADIOLOGY CONSULTANTS PLLC
LastName:  
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Mailing Information
Address1: PO BOX 98341
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850380341
CountryCode: US
TelephoneNumber: 4809409729
FaxNumber: 4809409730
Practice Location
Address1: 15215 S 48TH ST
Address2: BLDG 1, STE 110
City: PHOENIX
State: AZ
PostalCode: 850449142
CountryCode: US
TelephoneNumber: 4809409729
FaxNumber: 4809409730
Other Information
ProviderEnumerationDate: 08/26/2006
LastUpdateDate: 11/08/2007
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: COHEN
AuthorizedOfficialFirstName: JORDAN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4809409729
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D,
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X19571AZY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
84155305AZ MEDICAID


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