Certified Surgical First Assistant
Physician Assistant, Surgical in Chandler, AZ. Organization (NPI-2).
NPI number1457714388
StatusActive
Last updated in NPPESJan 11, 2022
Details
- NPI
- 1457714388
- Entity type
- Organization (NPI-2)
- Legal business name
- Certified Surgical First Assistant
- Organization subpart
- No
- Enumeration date
- Mar 29, 2016
- Certification date
- Jan 11, 2022
- Last updated
- Jan 11, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | – | – | Yes |
| 246ZC0007X | Specialist/Technologist, Other, Surgical Assistant | – | – |
Practice location
2925 E Riggs RdSte 8-166
Chandler, AZ 85249-3600
Phone 480-545-2610 · Fax 480-545-2673
Mailing address
2925 E Riggs RdSte 8-166
Chandler, AZ 85249-3600
Phone 602-909-4623 · Fax 480-545-2673
Authorized official
Kathleen E Bagwell
General Manager
4805452610
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