Provider Demographics
NPI:1578513537
Name:MADRIL, AMY C (MD, PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:MADRIL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:LISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16406 W PIMA ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 SANDY CORNER RD
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9844
Practice Address - Country:US
Practice Address - Phone:979-543-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31041207Q00000X
MO2022007355207Q00000X
TXT7639207Q00000X
AZ51179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZFM5909421OtherDEA
KSFM1004047OtherDEA
MOFM1324475OtherDEA