Provider Demographics
NPI:1669604294
Name:ARIZONA VASCULAR INSTITUTE,LLC
Entity type:Organization
Organization Name:ARIZONA VASCULAR INSTITUTE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-586-4297
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-0776
Mailing Address - Country:US
Mailing Address - Phone:480-586-4297
Mailing Address - Fax:480-497-4563
Practice Address - Street 1:2730 S VAL VISTA DR STE 152
Practice Address - Street 2:BLDG. 9
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1682
Practice Address - Country:US
Practice Address - Phone:480-586-4297
Practice Address - Fax:480-497-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-15
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ404172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty