Provider Demographics
NPI:1164475901
Name:SOBCZAK, JACEK (MD)
Entity Type:Individual
Prefix:
First Name:JACEK
Middle Name:
Last Name:SOBCZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10474 W THUNDERBIRD BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3023
Mailing Address - Country:US
Mailing Address - Phone:623-972-3800
Mailing Address - Fax:623-972-1089
Practice Address - Street 1:7304 E DEER VALLEY RD
Practice Address - Street 2:SUITE E100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7450
Practice Address - Country:US
Practice Address - Phone:623-972-3800
Practice Address - Fax:623-972-1089
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ352012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106253Medicaid
AZ106253Medicaid
AZI00096Medicare UPIN