Provider Demographics
NPI:1487032389
Name:WITTEN, ANTHONY MOBLEY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MOBLEY
Last Name:WITTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 E MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1218
Mailing Address - Country:US
Mailing Address - Phone:602-762-7939
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724
Practice Address - Country:US
Practice Address - Phone:520-626-8818
Practice Address - Fax:520-626-6020
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine