Provider Demographics
NPI:1679510606
Name:SCHWARTZ, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SCHWARTZ
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 1:5891 W EUGIE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1252
Mailing Address - Country:US
Mailing Address - Phone:602-588-6725
Mailing Address - Fax:602-588-6906
Practice Address - Street 1:5891 W/ EUGIE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2506
Practice Address - Country:US
Practice Address - Phone:602-588-6703
Practice Address - Fax:602-588-6906
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ374471Medicaid
AZ73460Medicare ID - Type Unspecified
AZ374471Medicaid