Provider Demographics
NPI:1558317107
Name:PRICHARD, PABLO ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:ANDRES
Last Name:PRICHARD
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:PO BOX 207435
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7433
Mailing Address - Country:US
Mailing Address - Phone:480-625-0003
Mailing Address - Fax:480-842-8760
Practice Address - Street 1:8900 E RAINTREE DR STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7307
Practice Address - Country:US
Practice Address - Phone:480-752-7874
Practice Address - Fax:480-842-8760
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34430208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ34430OtherMEDICAL
AZ966228Medicaid
AZ34430OtherMEDICAL
I 43146Medicare UPIN
AZ966228Medicaid