Provider Demographics
NPI:1003169236
Name:EDINGER, PERRY E (PA)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:E
Last Name:EDINGER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:024-063-1816
Mailing Address - Fax:022-642-4176
Practice Address - Street 1:19636 N 27TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4022
Practice Address - Country:US
Practice Address - Phone:623-562-5050
Practice Address - Fax:602-294-8277
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5225363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ786013Medicaid
AZ786013Medicaid