Provider Demographics
NPI:1609408194
Name:AZ REGENERATIVE MEDICNE
Entity Type:Organization
Organization Name:AZ REGENERATIVE MEDICNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-992-2656
Mailing Address - Street 1:16620 N 40TH ST STE G2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3351
Mailing Address - Country:US
Mailing Address - Phone:602-992-2656
Mailing Address - Fax:
Practice Address - Street 1:16620 N 40TH ST STE G2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3351
Practice Address - Country:US
Practice Address - Phone:602-992-2656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty