Provider Demographics
NPI:1831560176
Name:CAMELBACK ANESTHESIA PLLC
Entity type:Organization
Organization Name:CAMELBACK ANESTHESIA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:CITRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-425-2160
Mailing Address - Street 1:2421 E SOUTHERN AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7612
Mailing Address - Country:US
Mailing Address - Phone:480-425-2160
Mailing Address - Fax:480-351-8797
Practice Address - Street 1:2421 E SOUTHERN AVE
Practice Address - Street 2:STE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7612
Practice Address - Country:US
Practice Address - Phone:480-425-2160
Practice Address - Fax:480-351-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19985207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty