Provider Demographics
NPI:1518960996
Name:DMOWSKI, ANDRZEJ (MD)
Entity Type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:
Last Name:DMOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-239-6968
Mailing Address - Fax:602-239-4144
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-239-6968
Practice Address - Fax:602-239-4144
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79755207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49780OtherBCBS
FL49780OtherBCBS
FLP00159264Medicare PIN
FLG60858Medicare UPIN