Provider Demographics
NPI:1548241235
Name:TANPHAICHITR, ARTTHAPOL (MD)
Entity Type:Individual
Prefix:
First Name:ARTTHAPOL
Middle Name:
Last Name:TANPHAICHITR
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 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:SUITE 124
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-584-2127
Mailing Address - Fax:623-546-9682
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:SUITE C-2
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-760-9449
Practice Address - Fax:623-974-9351
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50280207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ15848241235OtherBC/BS
AZ29415OtherAHCCCS
AZ29415OtherAHCCCS
H61899Medicare UPIN