Provider Demographics
NPI:1063450344
Name:BELZER, IRVIN SAM (MD)
Entity Type:Individual
Prefix:
First Name:IRVIN
Middle Name:SAM
Last Name:BELZER
Suffix:
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 1:3411 N 5TH AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3812
Mailing Address - Country:US
Mailing Address - Phone:602-789-0344
Mailing Address - Fax:602-870-7566
Practice Address - Street 1:2510 W DUNLAP AVE STE 290
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2759
Practice Address - Country:US
Practice Address - Phone:602-789-0344
Practice Address - Fax:602-789-8389
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21994207R00000X
NE11398207R00000X
AZ6258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21700101Medicaid
AZ21700101Medicaid
AZ1Z2819OtherHEALTH NET
AZ860354364OtherBLUE CROSS BLUE SHIELD AZ
AZ21700101Medicaid