Provider Demographics
NPI:1205027133
Name:LEY, ELLIE ZARA (MD)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:ZARA
Last Name:LEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 N SCOTTSDALE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3694
Mailing Address - Country:US
Mailing Address - Phone:480-889-6373
Mailing Address - Fax:480-657-9560
Practice Address - Street 1:7025 N SCOTTSDALE RD STE 302
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-3694
Practice Address - Country:US
Practice Address - Phone:480-889-6373
Practice Address - Fax:480-657-9560
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101116174400000X
AZ368762082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ701121OtherAHCCCS
UTU000069637Medicare UPIN