Phoenix Diabetes and Endocrinology, LLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

25915 Issued in AZ

Legal business name

PHOENIX DIABETES AND ENDOCRINOLOGY, LLC

Practice address

4045 E Union Hills Dr
A107
Phoenix, AZ 85050-3386

Phone

(602) 788-3636

Fax

(602) 788-3646

NPI assigned

Mar 24, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carole D Baker

Title

Office Administrator

Phone

(602) 788-3636

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283299200000",
    "number": "1265756977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 E UNION HILLS DR",
            "address_2": "A-107",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850503386",
            "telephone_number": "602-788-3636",
            "fax_number": "602-788-3646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 E UNION HILLS DR",
            "address_2": "A107",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850503386",
            "telephone_number": "602-788-3636",
            "fax_number": "602-788-3646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX DIABETES AND ENDOCRINOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-24",
        "last_updated": "2010-09-01",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "602-788-3636",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "AZ",
            "license": "25915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509712",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Endocrinology, Diabetes & Metabolism Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Endocrinology, Diabetes & Metabolism Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.