Provider Demographics
NPI:1568685477
Name:AHWATUKEE FOOTHILLS PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:AHWATUKEE FOOTHILLS PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:K
Authorized Official - Last Name:FARNWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-759-3001
Mailing Address - Street 1:15810 S 45TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7697
Mailing Address - Country:US
Mailing Address - Phone:480-759-3001
Mailing Address - Fax:480-759-1341
Practice Address - Street 1:15810 S 45TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7697
Practice Address - Country:US
Practice Address - Phone:480-759-3001
Practice Address - Fax:480-759-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171742086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty