Provider Demographics
NPI:1114110533
Name:LIMBERG, MANDY (DO)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:
Last Name:LIMBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1300 N 12TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2813
Mailing Address - Country:US
Mailing Address - Phone:602-239-6968
Mailing Address - Fax:
Practice Address - Street 1:1300 N 12TH ST STE 301
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2813
Practice Address - Country:US
Practice Address - Phone:602-239-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4680207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine