Brian D Dedinsky M.d., P.c. | |
367 E Virginia Ave Phoenix AZ 85004-1202 | |
(602) 256-6303 | |
(602) 256-6302 |
Full Name | Brian D Dedinsky M.d., P.c. |
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Speciality | Clinic/Center |
Location | 367 E Virginia Ave, Phoenix, Arizona |
Authorized Official Name and Position | Brian David Dedinsky (OWNER) |
Authorized Official Contact | 6022566303 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Brian D Dedinsky M.d., P.c. 367 E Virginia Ave Phoenix AZ 85004-1202 Ph: (602) 256-6303 | Brian D Dedinsky M.d., P.c. 367 E Virginia Ave Phoenix AZ 85004-1202 Ph: (602) 256-6303 |
NPI Number | 1114183209 |
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Provider Enumeration Date | 07/29/2008 |
Last Update Date | 06/17/2014 |
Medicare PECOS PAC ID | 2466528450 |
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Medicare Enrollment ID | O20080827000231 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114183209 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | AZ20400 (Arizona) | Secondary |
261QP2300X | Clinic/center - Primary Care | AZ20400 (Arizona) | Primary |
Provider Name | Brian D Dedinsky |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1730238106 PECOS PAC ID: 0941235980 Enrollment ID: I20050928001293 |
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