Provider Demographics
NPI:1083375307
Name:REGEN ADVANCED INFUSION AND WELLNESS
Entity Type:Organization
Organization Name:REGEN ADVANCED INFUSION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-341-5174
Mailing Address - Street 1:14067 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-5703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14067 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-5703
Practice Address - Country:US
Practice Address - Phone:602-380-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty