Provider Demographics
NPI:1114178571
Name:ARIZONA OTOLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:ARIZONA OTOLOGIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:DASPIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-279-5444
Mailing Address - Street 1:222 W THOMAS RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4419
Mailing Address - Country:US
Mailing Address - Phone:602-279-5444
Mailing Address - Fax:602-279-0188
Practice Address - Street 1:222 W THOMAS RD
Practice Address - Street 2:SUITE 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4419
Practice Address - Country:US
Practice Address - Phone:602-279-5444
Practice Address - Fax:602-279-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229379Medicaid
AZZ71549Medicare PIN
AZ229379Medicaid