1538120928 NPI number — WILLIAM VANARSDELL MD

Table of content: WILLIAM VANARSDELL MD (NPI 1538120928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538120928 NPI number — WILLIAM VANARSDELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANARSDELL
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1538120928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2702 NORTH 3RD STREET
Provider Second Line Business Mailing Address:
SUITE 4020
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85004-4608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-323-3344
Provider Business Mailing Address Fax Number:
602-323-3496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 COFCO CENTER COURT
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-6464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-243-7277
Provider Business Practice Location Address Fax Number:
602-286-0808
Provider Enumeration Date:
03/28/2006

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: 208000000X , with the licence number:  13372 , 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: D37775 . This is a "UPIN NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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