Provider Demographics
NPI:1689654790
Name:FIRESTONE, THEODORE PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:PHILLIP
Last Name:FIRESTONE
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 1:20401 N 73RD ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-237-5727
Mailing Address - Fax:480-657-3207
Practice Address - Street 1:20401 N 73RD ST
Practice Address - Street 2:STE 160
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-237-5727
Practice Address - Fax:480-657-3207
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ19529207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ296352Medicaid
AZ111926Medicare ID - Type Unspecified
E14745Medicare UPIN