Provider Demographics
NPI:1528067089
Name:QUIROZ, EDWARD ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ENRIQUE
Last Name:QUIROZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:809 E WASHINGTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1052
Mailing Address - Country:US
Mailing Address - Phone:602-340-1429
Mailing Address - Fax:602-340-1327
Practice Address - Street 1:809 E WASHINGTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1052
Practice Address - Country:US
Practice Address - Phone:602-340-9455
Practice Address - Fax:602-253-5359
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2009-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ16323208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ283268Medicaid
AZ283268Medicaid