Provider Demographics
NPI:1073801056
Name:ALL-STAR PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:ALL-STAR PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-832-0480
Mailing Address - Street 1:4915 E BASELINE RD STE 119
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2969
Mailing Address - Country:US
Mailing Address - Phone:480-832-0480
Mailing Address - Fax:480-832-0490
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:STE 119
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2965
Practice Address - Country:US
Practice Address - Phone:480-832-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ634489Medicaid