Provider Demographics
NPI:1912195587
Name:ARIZONA ORTHOPEDIC & SPORTS MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:ARIZONA ORTHOPEDIC & SPORTS MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-962-8485
Mailing Address - Street 1:1520 S DOBSON RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4700
Mailing Address - Country:US
Mailing Address - Phone:480-962-8485
Mailing Address - Fax:480-962-4210
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 312
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4700
Practice Address - Country:US
Practice Address - Phone:480-962-8485
Practice Address - Fax:480-962-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWDBFWMedicare UPIN
AZZWDBFWMedicare PIN