Provider Demographics
NPI:1700876604
Name:HOSS, NICK (MD)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:HOSS
Suffix:
Gender:M
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:PO BOX 81349
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-1349
Mailing Address - Country:US
Mailing Address - Phone:623-931-1225
Mailing Address - Fax:623-931-0088
Practice Address - Street 1:19829 N 27TH AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-931-1225
Practice Address - Fax:623-931-0088
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26976207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ439605OtherAHCCCS
AZAZ0743300OtherBCBS
AZAZ0743300OtherBCBS
AZ439605OtherAHCCCS