Basic Information
| Provider Information | |||||||||
| NPI: | 1952357022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SONORAN ORTHOPAEDIC TRAUMA SURGEONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3126 N CIVIC CENTER PLZ | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808742040 | ||||||||
| FaxNumber: | 4808742041 | ||||||||
| Practice Location | |||||||||
| Address1: | 3126 N CIVIC CENTER PLZ | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808742040 | ||||||||
| FaxNumber: | 4808742041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 11/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | RHORER | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4808742040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0801X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 433622 | 05 | AZ | MEDICAID |