Provider Demographics
NPI:1033106281
Name:MAFFI, TERRY R I (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:MAFFI
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE E200
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5927
Mailing Address - Country:US
Mailing Address - Phone:480-505-6430
Mailing Address - Fax:480-505-6429
Practice Address - Street 1:5410 N SCOTTSDALE RD
Practice Address - Street 2:SUITE E200
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5927
Practice Address - Country:US
Practice Address - Phone:480-505-6430
Practice Address - Fax:480-505-6429
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32805208200000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868292Medicaid
AZAZ0768540OtherBC OF AZ PROVIDER NUMBER
AZAZ0768540OtherBC OF AZ PROVIDER NUMBER
AZ101786Medicare ID - Type Unspecified