| Organization Name: | KODY MEDICAL PC |
| NPI Number: | 1033482435 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK ALEXANDER MATHURIN (CEO) |
| Mailing Address: | 11627 N 12th Pl Phoenix |
| State: | AZ US |
| Postal Code: | 850201222 |
| Phone Number: | 6027992133 |
| Fax Number: | 6029971418 |
| NPI Enumeration Date: | 02/15/2012 |
| NPI Last Update Date: | 11/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 23700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |