1376506683 NPI number — SCOTT F ALEXANDER M.D.

Table of content: SCOTT F ALEXANDER M.D. (NPI 1376506683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376506683 NPI number — SCOTT F ALEXANDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
SCOTT
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376506683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36680
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85067-6680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-285-9550
Provider Business Mailing Address Fax Number:
602-234-3748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W THOMAS RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-285-9550
Provider Business Practice Location Address Fax Number:
602-234-3748
Provider Enumeration Date:
04/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  16316 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: XPY091750 . This is a "MEDI-CAL OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0251300 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ6453 . This is a "HEALTHNET OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 264309 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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