Provider Demographics
NPI:1164683793
Name:EGNATIOS, GENEVIEVE L (MD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:L
Last Name:EGNATIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11333 N SCOTTSDALE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5186
Mailing Address - Country:US
Mailing Address - Phone:480-998-1400
Mailing Address - Fax:
Practice Address - Street 1:11333 N SCOTTSDALE RD STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5186
Practice Address - Country:US
Practice Address - Phone:480-998-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42177207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ450597Medicaid
AZ450597Medicaid