Provider Demographics
NPI:1578517827
Name:JOSEPHSON, ALAN I
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:I
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:
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 32950
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-2950
Mailing Address - Country:US
Mailing Address - Phone:602-433-1822
Mailing Address - Fax:602-246-7060
Practice Address - Street 1:1804 W ELLIOT RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1004
Practice Address - Country:US
Practice Address - Phone:480-456-0444
Practice Address - Fax:480-456-0449
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22106208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ371782Medicaid
AZ371782Medicaid