Provider Demographics
NPI:1710958517
Name:SELLERS, JOEL SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:SCOTT
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 E BASELINE RD STE C-1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1527
Mailing Address - Country:US
Mailing Address - Phone:480-426-2667
Mailing Address - Fax:480-751-3785
Practice Address - Street 1:1840 E BASELINE RD STE C-1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1527
Practice Address - Country:US
Practice Address - Phone:480-426-2667
Practice Address - Fax:480-751-3785
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101314Medicare PIN
AZZ100183Medicare PIN