Provider Demographics
NPI:1073911921
Name:RAYMOND P ROFFI MDPC
Entity Type:Organization
Organization Name:RAYMOND P ROFFI MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAOU
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:480-821-3713
Mailing Address - Street 1:485 S DOBSON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5603
Mailing Address - Country:US
Mailing Address - Phone:480-821-3710
Mailing Address - Fax:480-821-3708
Practice Address - Street 1:485 S DOBSON RD STE 107
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5603
Practice Address - Country:US
Practice Address - Phone:480-821-3710
Practice Address - Fax:480-821-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21337207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20014368OtherRAILROAD MEDICARE
AZ127838OtherAHCCCS
AZMD21337OtherMEDICARE
AZ051448OtherAETNA
AZ051448OtherAETNA