Provider Demographics
NPI:1144233784
Name:ARIZONA CENTER FOR NEUROLOGIC MEDICINE, PC
Entity Type:Organization
Organization Name:ARIZONA CENTER FOR NEUROLOGIC MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:REISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-200-6999
Mailing Address - Street 1:2702 N 3RD ST STE 2007
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4606
Mailing Address - Country:US
Mailing Address - Phone:602-200-6999
Mailing Address - Fax:602-200-6990
Practice Address - Street 1:2702 N 3RD ST STE 2007
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4606
Practice Address - Country:US
Practice Address - Phone:602-200-6999
Practice Address - Fax:602-200-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ214452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF54224Medicare UPIN