Provider Demographics
NPI:1659475937
Name:BADER, SARA J (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:J
Last Name:BADER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10645 N TATUM BLVD
Mailing Address - Street 2:#200-564
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028
Mailing Address - Country:US
Mailing Address - Phone:480-947-7712
Mailing Address - Fax:888-942-3960
Practice Address - Street 1:7301 EAST SECOND STREET
Practice Address - Street 2:SUITE 315
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5627
Practice Address - Country:US
Practice Address - Phone:480-947-7711
Practice Address - Fax:480-994-8530
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
67102Medicare ID - Type Unspecified
AZP39178Medicare UPIN
P39178Medicare UPIN