Provider Demographics
NPI:1396953998
Name:LE, PHUC (MD)
Entity type:Individual
Prefix:
First Name:PHUC
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4394
Mailing Address - Country:US
Mailing Address - Phone:480-835-6100
Mailing Address - Fax:480-461-4243
Practice Address - Street 1:8765 E BELL RD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1320
Practice Address - Country:US
Practice Address - Phone:480-835-6100
Practice Address - Fax:480-461-4243
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36659207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223841Medicaid