Provider Demographics
NPI:1538335641
Name:THE UROLOGY CLINIC
Entity type:Organization
Organization Name:THE UROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-951-3275
Mailing Address - Street 1:10503 W THUNDERBIRD BLVD STE 317
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3049
Mailing Address - Country:US
Mailing Address - Phone:623-974-3621
Mailing Address - Fax:623-974-0511
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 317
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3049
Practice Address - Country:US
Practice Address - Phone:623-974-3621
Practice Address - Fax:623-974-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5046208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ326237OtherAHCCCS
AZ326237OtherAHCCCS