Organization Name: | MD WELLNESS CENTERS SCOTTSDALE LLC |
NPI Number: | 1740651025 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARCUS SOUTHWORTH (MANAGER/OWNER) |
Mailing Address: | 7555 E Osborn Rd Ste 200 Scottsdale |
State: | AZ US |
Postal Code: | 852516434 |
Phone Number: | 4804365151 |
Fax Number: | 4804365153 |
NPI Enumeration Date: | 10/13/2015 |
NPI Last Update Date: | 10/15/2015 |
Replacement NPI: | 0 |
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NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
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