Provider Demographics
NPI:1689848590
Name:LINSTROM, NATHAN J (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:LINSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 W BROWN RD
Mailing Address - Street 2:9N-05
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3202
Mailing Address - Country:US
Mailing Address - Phone:480-684-5066
Mailing Address - Fax:480-684-5027
Practice Address - Street 1:37000 N GANTZEL RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7303
Practice Address - Country:US
Practice Address - Phone:480-394-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ341452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology