Provider Demographics
NPI:1467444166
Name:PAGAN, LIZZETTE (MD)
Entity Type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:PAGAN
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:PO BOX 20631
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85036-0631
Mailing Address - Country:US
Mailing Address - Phone:602-716-5700
Mailing Address - Fax:602-716-5842
Practice Address - Street 1:1823 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3052
Practice Address - Country:US
Practice Address - Phone:602-716-5700
Practice Address - Fax:602-716-5842
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-10-27
Deactivation Date:2006-04-10
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
AZAZ27535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ469941Medicaid