Provider Demographics
NPI:1093900169
Name:PAPAGO BUTTES PEDIATRIC CENTER, P.C.
Entity Type:Organization
Organization Name:PAPAGO BUTTES PEDIATRIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:REZNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-778-1732
Mailing Address - Street 1:8573 E SAN ALBERTO DR
Mailing Address - Street 2:SUITE E-100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4383
Mailing Address - Country:US
Mailing Address - Phone:480-778-1732
Mailing Address - Fax:480-778-1709
Practice Address - Street 1:8573 E SAN ALBERTO DR
Practice Address - Street 2:SUITE E-100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4383
Practice Address - Country:US
Practice Address - Phone:480-778-1732
Practice Address - Fax:480-778-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty