Facts
- Status
- A
- Credential
- P.T.
- Type
- Individual
- Enumeration date
- 2008-06-20
- Last updated
- 2008-06-20
Specialties
Licenses
- License AZ
- 1858
Location
- Practice location
- 505 JACKS CANYON RD
- City
- SEDONA AZ
- Postal code
- 863517856
- Phone
- 928-284-1000
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.