Provider Demographics
NPI:1093722142
Name:ANSEL, ALAN LEE (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
Last Name:ANSEL
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:PO BOX 7779
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011
Mailing Address - Country:US
Mailing Address - Phone:602-252-2133
Mailing Address - Fax:602-258-0123
Practice Address - Street 1:2034 E SOUTHERN
Practice Address - Street 2:4
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:602-252-2133
Practice Address - Fax:602-258-0123
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ78082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ213877Medicaid
C99062Medicare UPIN
AZ213877Medicaid