Provider Demographics
| NPI: | 1356551550 |
|---|---|
| Name: | MEARS, MARGARET (MD) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | MARGARET |
| Middle Name: | |
| Last Name: | MEARS |
| Suffix: | |
| Gender: | F |
| Credentials: | MD |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 11026 N COGGINS DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SUN CITY |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85351-4211 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-421-3881 |
| Mailing Address - Fax: | 623-455-3582 |
| Practice Address - Street 1: | 11026 N COGGINS DR |
| Practice Address - Street 2: | |
| Practice Address - City: | SUN CITY |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85351-4211 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-421-3881 |
| Practice Address - Fax: | 623-455-3582 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2007-05-23 |
| Last Update Date: | 2012-07-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AZ | AZ 14076 | 208100000X |
| AZ | AZ14076 | 207R00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 249848 | Other | AHCCCS |
| AZ | 14076 | Other | STATE MEDICAL LICENSE |
| AZ | 249848 | Other | AHCCCS |