Provider Demographics
NPI:1922126085
Name:ARIZONA HEAD NECK & FACIAL SURGERY LTD
Entity Type:Organization
Organization Name:ARIZONA HEAD NECK & FACIAL SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:NUTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-258-9859
Mailing Address - Street 1:1515 N 9TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-258-9859
Mailing Address - Fax:602-256-0820
Practice Address - Street 1:1515 N 9TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-258-9859
Practice Address - Fax:602-256-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID