Mirage Medical LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

5988 Issued in AZ

Legal business name

MIRAGE MEDICAL LLC

Practice address

10046 N Metro Pkwy W
Suite 115
Phoenix, AZ 85051-1437

Phone

(602) 674-5515

Fax

(602) 674-3029

NPI assigned

Nov 13, 2013

Last updated

Nov 13, 2013By 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

Dr. Jeremy R Buckner, D.C.

Title

Owner

Phone

(602) 421-2730

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1609206549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E WARNER RD",
            "address_2": "SUITE 107",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843224",
            "telephone_number": "480-264-3744",
            "fax_number": "480-264-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10046 N METRO PKWY W",
            "address_2": "SUITE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850511437",
            "telephone_number": "602-674-5515",
            "fax_number": "602-674-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRAGE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-13",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "BUCKNER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-421-2730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP4986",
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "AZ",
            "license": "AP2828",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "AZ",
            "license": "5988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Mark Mirabelli, DMD
• Miracle Consulting (Behavioral Group Innovations(BGI))
• Miracle on 29TH Street (Koala-D Meds)
• Miracle Wellness Center LLC
• Mirage Hospice Care Inc
• Mirage Podiatry Foot and Ankle Specialists
• Gregory Miraglia, PHARM. D.
• Ester Mirakov Cohen, CRANIAL PROSTHESIS
• Miranda Physical Therapy LLC
• Alyvia Leigh Miranda, LMSW

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.