Provider Demographics
NPI:1588667109
Name:BIDWELL, GEORGETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGETTA
Middle Name:
Last Name:BIDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E CAMELBACK RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2322
Mailing Address - Country:US
Mailing Address - Phone:602-997-0484
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:4901 W. MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-0000
Practice Address - Country:US
Practice Address - Phone:623-849-9088
Practice Address - Fax:623-849-7875
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7104207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ299108Medicaid
AZ299108Medicaid
AZ71570Medicare PIN