Provider Demographics
NPI:1710213244
Name:CANTON PEDIATRICS,PC
Entity Type:Organization
Organization Name:CANTON PEDIATRICS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-232-2737
Mailing Address - Street 1:303 E BASELINE RD
Mailing Address - Street 2:203
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6530
Mailing Address - Country:US
Mailing Address - Phone:602-232-2737
Mailing Address - Fax:602-232-2736
Practice Address - Street 1:303 E BASELINE RD
Practice Address - Street 2:203
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6530
Practice Address - Country:US
Practice Address - Phone:602-232-2737
Practice Address - Fax:602-232-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-17
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4498261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care