Provider Demographics
NPI:1376198325
Name:ARIZONA PREFERRED PODIATRY MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ARIZONA PREFERRED PODIATRY MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-907-8319
Mailing Address - Street 1:PO BOX 9058
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-9058
Mailing Address - Country:US
Mailing Address - Phone:480-907-8217
Mailing Address - Fax:
Practice Address - Street 1:2919 S ELLSWORTH RD STE 124
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2167
Practice Address - Country:US
Practice Address - Phone:480-907-8217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty