Provider Demographics
NPI:1164698783
Name:ACADEMIC UROLOGY AND UROGYNECOLOGY OF ARIZONA PC
Entity Type:Organization
Organization Name:ACADEMIC UROLOGY AND UROGYNECOLOGY OF ARIZONA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-547-2600
Mailing Address - Street 1:14044 W CAMELBACK RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9428
Mailing Address - Country:US
Mailing Address - Phone:623-547-2600
Mailing Address - Fax:
Practice Address - Street 1:14044 W CAMELBACK RD
Practice Address - Street 2:SUITE 118 AND 216
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9428
Practice Address - Country:US
Practice Address - Phone:623-547-2600
Practice Address - Fax:623-547-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-03
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33193208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ575948Medicaid
AZZ180474OtherPRESCOTT- PTAN
AZZ180412OtherMARICOPA PTAN
AZI32289Medicare UPIN