| Identity Hormones Llc | |
|
100 E Camelback Rd Ste 108 Phoenix AZ 85012-1061 | |
| (901) 757-3643 | |
| Not Available |
| Full Name | Identity Hormones Llc |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 100 E Camelback Rd Ste 108, Phoenix, Arizona |
| Authorized Official Name and Position | Teah Michelle Smith (CREDENTIALING MANAGER) |
| Authorized Official Contact | 9012053999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Identity Hormones Llc 100 E Camelback Rd Ste 108 Phoenix AZ 85012-1061 Ph: () - | Identity Hormones Llc 100 E Camelback Rd Ste 108 Phoenix AZ 85012-1061 Ph: (901) 757-3643 |
| NPI Number | 1326642372 |
|---|---|
| Provider Enumeration Date | 11/30/2020 |
| Last Update Date | 11/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326642372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
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