Provider Demographics
NPI:1083764278
Name:MAYES, SCOTT MICHAEL (PCC)
Entity Type:Individual
Prefix:PROF
First Name:SCOTT
Middle Name:MICHAEL
Last Name:MAYES
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13555 W MCDOWELL RD STE 208
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2628
Mailing Address - Country:US
Mailing Address - Phone:623-512-4155
Mailing Address - Fax:623-512-4152
Practice Address - Street 1:13555 W MCDOWELL RD STE 208
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2628
Practice Address - Country:US
Practice Address - Phone:623-512-4155
Practice Address - Fax:623-512-4152
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ692310Medicaid