Provider Demographics
NPI:1588665681
Name:UNDERWOOD, PAUL LESTER (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LESTER
Last Name:UNDERWOOD
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 1:8414 E SHEA BLVD
Mailing Address - Street 2:#103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6665
Mailing Address - Country:US
Mailing Address - Phone:480-767-3877
Mailing Address - Fax:480-767-3878
Practice Address - Street 1:8414 E SHEA BLVD
Practice Address - Street 2:#103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6665
Practice Address - Country:US
Practice Address - Phone:480-767-3877
Practice Address - Fax:480-767-3878
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ168965Medicaid
F75882Medicare UPIN
AZZ115989Medicare PIN