Provider Demographics
NPI:1013390343
Name:VEATCH, PHILLIP (PA-C)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:VEATCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 E SOUTHERN AVE STE O
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7519
Mailing Address - Country:US
Mailing Address - Phone:480-400-6225
Mailing Address - Fax:480-718-8709
Practice Address - Street 1:2034 E SOUTHERN AVE STE O
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7519
Practice Address - Country:US
Practice Address - Phone:480-400-6225
Practice Address - Fax:480-718-8709
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0000Medicaid