Provider Demographics
NPI:1013632843
Name:BELFORD, JUSTIN MARKEL (NP-C)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MARKEL
Last Name:BELFORD
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 N 126TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6382
Mailing Address - Country:US
Mailing Address - Phone:623-695-4011
Mailing Address - Fax:
Practice Address - Street 1:3426 N 126TH DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6382
Practice Address - Country:US
Practice Address - Phone:623-695-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP287368363LF0000X
AZRN177541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNP-COtherARIZONA BOARD OF NURSING