Provider Demographics
NPI:1578515458
Name:PHELPS, WILLIAM L II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:PHELPS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 W. DUVAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5280
Mailing Address - Country:US
Mailing Address - Phone:520-625-2950
Mailing Address - Fax:520-625-2997
Practice Address - Street 1:101 W. DUVAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5280
Practice Address - Country:US
Practice Address - Phone:520-625-2950
Practice Address - Fax:520-625-2997
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24727207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG47605Medicare UPIN