Az Fidelis PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

13423 Issued in AZ

Legal business name

AZ FIDELIS PLLC

Practice address

7702 E Doubletree Ranch Rd
Ste 300
Scottsdale, AZ 85258-2129

Phone

(877) 408-2488

Fax

(866) 776-6641

NPI assigned

Dec 20, 2008

Last updated

Mar 27, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Glen A Halvorson, MD

Title

Ceo

Phone

(877) 408-2488

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1229731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1558507657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7702 E DOUBLETREE RANCH RD",
            "address_2": "STE 300",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852582129",
            "telephone_number": "877-408-2488",
            "fax_number": "866-776-6641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7702 E DOUBLETREE RANCH RD",
            "address_2": "STE 300",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852582129",
            "telephone_number": "877-408-2488",
            "fax_number": "866-776-6641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ FIDELIS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-20",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "HALVORSON",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-408-2488",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AZ",
            "license": "13423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "13423",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.