Provider Demographics
NPI:1437324985
Name:MORTON H DUBNOW MD PLLC
Entity Type:Organization
Organization Name:MORTON H DUBNOW MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUBNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-682-7203
Mailing Address - Street 1:5040 N 15TH AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3328
Mailing Address - Country:US
Mailing Address - Phone:602-682-7203
Mailing Address - Fax:602-682-7806
Practice Address - Street 1:5040 N 15TH AVE
Practice Address - Street 2:STE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3328
Practice Address - Country:US
Practice Address - Phone:602-682-7203
Practice Address - Fax:602-682-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD36780Medicare UPIN