Provider Demographics
NPI:1205185220
Name:PHOENIX HEAD AND NECK SURGERY LTD
Entity Type:Organization
Organization Name:PHOENIX HEAD AND NECK SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALDREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-254-9398
Mailing Address - Street 1:4250 E CAMELBACK RD STE K250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2777
Mailing Address - Country:US
Mailing Address - Phone:602-254-9398
Mailing Address - Fax:
Practice Address - Street 1:4250 E CAMELBACK RD STE K250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2777
Practice Address - Country:US
Practice Address - Phone:602-254-9398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12576174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty