Provider Demographics
NPI:1417221623
Name:EDWARD G SCATES DPM PC
Entity Type:Organization
Organization Name:EDWARD G SCATES DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCATES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-955-4515
Mailing Address - Street 1:3832 E. THOMAS ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7510
Mailing Address - Country:US
Mailing Address - Phone:602-955-4515
Mailing Address - Fax:602-955-7096
Practice Address - Street 1:3832 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7510
Practice Address - Country:US
Practice Address - Phone:602-955-4515
Practice Address - Fax:602-955-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0326213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDPM326Medicare UPIN