Provider Demographics
NPI:1619974078
Name:ORCHARD, JOHN PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:ORCHARD
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 1:4444 N 32ND ST
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3956
Mailing Address - Country:US
Mailing Address - Phone:602-952-0002
Mailing Address - Fax:602-224-9119
Practice Address - Street 1:4444 N 32ND ST
Practice Address - Street 2:SUITE 175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3956
Practice Address - Country:US
Practice Address - Phone:602-952-0002
Practice Address - Fax:602-224-9119
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11799207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224981Medicaid
AZAZ0776390OtherBC/BS OF AZ
AZ2Z2848OtherHEALTH NET
AZD00075Medicare UPIN
AZ224981Medicaid