1932240736 NPI number — DR. ROBERT OTTO ENDRES PHD, D.ABHI

Table of content: DR. ROBERT OTTO ENDRES PHD, D.ABHI (NPI 1932240736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932240736 NPI number — DR. ROBERT OTTO ENDRES PHD, D.ABHI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENDRES
Provider First Name:
ROBERT
Provider Middle Name:
OTTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, D.ABHI
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:
1932240736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLOOD SYSTEMS LABORATORIES
Provider Second Line Business Mailing Address:
2424 W ERIE DR
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-343-7092
Provider Business Mailing Address Fax Number:
602-343-7025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLOOD SYSTEMS LABORATORIES
Provider Second Line Business Practice Location Address:
2424 W ERIE DR
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-343-7092
Provider Business Practice Location Address Fax Number:
602-343-7025
Provider Enumeration Date:
02/12/2007

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: 170100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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